Active NPI
Prasanna S. Srinagesh MD PC
- Nephrology Physician
- Waycross, GA
National Provider Identifier
1154835965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 66648
- Legal business name
- PRASANNA S. SRINAGESH MD PC
- Practice address
- 220 Uvalda St
Waycross, GA 31501-4569 - Phone
- (912) 285-2053
- Fax
- (912) 283-5520
- NPI assigned
- Dec 1, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Prasanna Srinagesh, MD
- Title
- President
- Phone
- (912) 285-2053
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 66648 | GA | Primary |
Addresses
Primary practice location
220 Uvalda St
Waycross, GA 31501-4569
Mailing address
PO Box 1506
Waycross, GA 31502-1506
Phone (912) 285-2053
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003112851A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180126000850 | GA | Part B Supplier - Clinic/Group Practice | 9931468626 |
Receives reassigned benefits from 2 practitioners Practice locations: Alma, GA |
National Provider Directory
National Provider DirectoryLocations
501 Riverside Dr
Waycross, GA 31501
Phone (912) 283-6152
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512086400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1512086400000",
"number": "1154835965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1506",
"city": "WAYCROSS",
"state": "GA",
"postal_code": "315021506",
"telephone_number": "912-285-2053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 UVALDA ST",
"city": "WAYCROSS",
"state": "GA",
"postal_code": "315014569",
"telephone_number": "912-285-2053",
"fax_number": "912-283-5520"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRASANNA S. SRINAGESH MD PC",
"organizational_subpart": "NO",
"enumeration_date": "2017-12-01",
"last_updated": "2017-12-01",
"status": "A",
"authorized_official_last_name": "SRINAGESH",
"authorized_official_first_name": "PRASANNA",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "912-285-2053",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Nephrology",
"state": "GA",
"license": "66648",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003112851A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waycross, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.