Individual provider Active NPI

Deepthi Koralla, DO

  • Hospitalist Physician
  • Decatur, GA
National Provider Identifier
1174109078
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
101075 Issued in GA
Practice address
2701 N Decatur Rd
Decatur, GA 30033-5918
Phone
(404) 501-1000
NPI assigned
Mar 22, 2021
Last updated
Oct 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OT020792 PA
Internal Medicine Physician 207R00000X 101075 GA
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist Physician 208M00000X 101075 GA Primary

Addresses

Primary practice location

2701 N Decatur Rd
Decatur, GA 30033-5918

Mailing address

1007 Autumn River Run
Philadelphia, PA 19128-4362
Phone (614) 717-5665

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20241112002701 GA Practitioner - Internal MedicinePractitioner - Hospitalist 2163828815 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Philadelphia College of Osteopathic Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emory Specialty Associates, LLCGroup PAC ID 3476559782, 706 clinicians

Practice addresses (Care Compare)

1821 Clifton Rd NE
Atlanta, GA 30329-4021
Phone (404) 728-6812

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
101075GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Specialty Associates, LLC Internal Medicine CurrentSince Aug 16, 2024 Accepting new patients
Dekalb Medical Center, Inc. Past Accepting new patients
Dekalb Medical Psych Unit Past Accepting new patients

Locations

1821 Clifton Rd NE
Atlanta, GA 30329
Phone (404) 728-6812

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

2701 N Decatur Rd
Decatur, GA 30033
Phone (404) 501-1000

Organizations & group practices 3

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": "1616371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1174109078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 AUTUMN RIVER RUN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191284362",
            "telephone_number": "614-717-5665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 N DECATUR RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300335918",
            "telephone_number": "404-501-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORALLA",
        "first_name": "DEEPTHI",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-22",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OT020792",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "101075",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "101075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

Verify at the official NPI Registry.