Individual provider Active NPI

Selamawit Woldekidan Woldemariam, M.D.

  • Internal Medicine Physician
  • Gainesville, GA
National Provider Identifier
1164881975
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
83808 Issued in GA
Practice address
743 Spring St NE
Gainesville, GA 30501
Phone
(770) 219-9000
NPI assigned
Feb 22, 2016
Last updated
Aug 15, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 83808 GA Primary
Internal Medicine Physician 207R00000X MT210107 PA

Addresses

Primary practice location

743 Spring St NE
Gainesville, GA 30501

Mailing address

PO Box 742616
Atlanta, GA 30374-2616
Phone (770) 219-8420

Other practice location 1

250 S 21st St
Easton, PA 18042-3851
Phone (720) 998-4943

Other practice location 2

250 S 21st St
Easton, PA 18042-3851
Phone (720) 998-4943

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200806001925 SC Practitioner - Internal Medicine 5294029658 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Hospitalist Services PCGroup PAC ID 3476855420, 301 clinicians

Practice addresses (Care Compare)

9330 Medical Plaza Dr
Charleston, SC 29406-9104
Phone (843) 847-4559

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
83808GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Hospitalist Services PC Internal Medicine CurrentSince Jul 1, 2020 Accepting new patients
Trident Medical Center, LLC Past Accepting new patients

Locations

809 82nd Pkwy
Myrtle Beach, SC 29572
Phone (843) 291-7182

9330 Medical Plaza Dr
North Charleston, SC 29406
Phone (843) 554-6366

295 Midland Pkwy
Summerville, SC 29485
Phone (843) 554-6366

Organizations & group practices 2

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 1

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": "1456099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1164881975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742616",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742616",
            "telephone_number": "770-219-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 SPRING ST NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "770-219-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 S 21st St",
            "address_purpose": "LOCATION",
            "city": "Easton",
            "state": "PA",
            "postal_code": "180423851",
            "country_code": "US",
            "telephone_number": "720-998-4943",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 S 21st St",
            "address_purpose": "LOCATION",
            "city": "Easton",
            "state": "PA",
            "postal_code": "180423851",
            "country_code": "US",
            "telephone_number": "720-998-4943",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLDEMARIAM",
        "first_name": "SELAMAWIT",
        "middle_name": "WOLDEKIDAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-22",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "83808",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT210107",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.