NPIMap

Individual provider Active NPI

Dipenkumar Rameshchandra Patel, M.D.

  • Family Medicine Physician
  • Macon, GA
National Provider Identifier
1124407499
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
080444 Issued in GA
Practice address
3400 Riverside Dr
Macon, GA 31210-2513
Phone
(478) 474-5600
Fax
(478) 471-6769
NPI assigned
May 20, 2015
Last updated
Sep 16, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 080444 GA Primary

Addresses

Primary practice location

3400 Riverside Dr
Macon, GA 31210-2513

Mailing address

3400 Riverside Dr
Macon, GA 31210-2513
Phone (478) 474-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181009000715 GA Practitioner - Family Practice 2860701216 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southern Primary Care, LLCGroup PAC ID 3173897196, 5 clinicians

Practice addresses (Care Compare)

6501 Peake Rd
Suite 400
Macon, GA 31210-8046
Phone (478) 477-0966

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Primary Care, LLC CurrentSince Oct 22, 2018 Accepting new patients
Pruitthealth - Toomsboro, LLC Past Accepting new patients
Church Home Rehabilitation and Healthcare, LLC Past Accepting new patients
Christ's Sanctified Holy Church, Inc. Past Accepting new patients

Locations

197 Bass Rd
Macon, GA 31210
Phone (478) 365-2164

6501 Peake Rd
Ste 400
Macon, GA 31210
Phone (478) 477-0966

101 Willie Lee Pkwy
Ste 400
Warner Robins, GA 31088
Phone (478) 242-3880

Interoperability endpoints

  • Direct secure messaging: dpatel433714@carolinashealthcaresystem.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Church Home Rehabilitation and Healthcare, LLCFort Valley, GA, CCN 115708 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2022
Jul 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1124407499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 RIVERSIDE DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102513",
            "telephone_number": "478-474-5600",
            "fax_number": "478-471-6769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 RIVERSIDE DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102513",
            "telephone_number": "478-474-5600",
            "fax_number": "478-471-6769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "DIPENKUMAR",
        "middle_name": "RAMESHCHANDRA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-20",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "080444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.