NPIMap

Individual provider Active NPI

Hironobu Takeda, DO

  • Internal Medicine Physician
  • Douglasville, GA
National Provider Identifier
1164929568
Registry record updated Apr 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
93245 Issued in GA
Practice address
6043 Prestley Mill Rd Ste B
Douglasville, GA 30134-2280
Phone
(770) 941-8100
Fax
(678) 945-9331
NPI assigned
Apr 11, 2018
Last updated
Apr 19, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 93245 GA Primary

Addresses

Primary practice location

6043 Prestley Mill Rd Ste B
Douglasville, GA 30134-2280

Mailing address

6043 Prestley Mill Rd Ste B
Douglasville, GA 30134-2280
Phone (770) 941-8100

Other practice location 1

665 Duluth Hwy Ste 401
Lawrenceville, GA 30046-4303
Phone (678) 312-4074

Other practice location 2

300 W 27th St
Lumberton, NC 28358-3075
Phone (910) 671-5000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address htakeda503646@directwellstar.org Health Information Exchange (HIE)

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
I20221014000206 GA Practitioner - Internal Medicine 8921332750 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

6043 Prestley Mill Rd
Douglasville, GA 30134-2280

6043 Prestley Mill Rd C
Douglasville, GA 30134-2280
Phone (770) 920-3076

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.02 of 100Reported as group
Quality
57.87
Promoting interoperability
100
Improvement activities
40
Cost
75.97

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tift Regional Health System Inc CurrentSince Nov 8, 2022 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Tift Regional Health System Inc Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Oct 15, 2022 Accepting new patients
Tift Regional Health System Inc CurrentSince Nov 8, 2022 Accepting new patients

Locations

6043 Prestley Mill Rd
Ste B
Douglasville, GA 30134
Phone (770) 941-8100

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616

2227 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-6188

Organizations & group practices 5

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 6

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": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1164929568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6043 PRESTLEY MILL RD STE B",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301342280",
            "telephone_number": "770-941-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6043 PRESTLEY MILL RD STE B",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301342280",
            "telephone_number": "770-941-8100",
            "fax_number": "678-945-9331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "665 Duluth Hwy Ste 401",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300464303",
            "country_code": "US",
            "telephone_number": "678-312-4074",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 W 27th St",
            "address_purpose": "LOCATION",
            "city": "Lumberton",
            "state": "NC",
            "postal_code": "283583075",
            "country_code": "US",
            "telephone_number": "910-671-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAKEDA",
        "first_name": "HIRONOBU",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-11",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "93245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "htakeda503646@directwellstar.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "6043 Prestley Mill Rd Ste B",
            "city": "Douglasville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301342280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Douglasville, GA

Sources for this page

Verify at the official NPI Registry.