Individual provider Active NPI

Samina Bhatti, M.D.

  • Internal Medicine Physician
  • McDonough, GA
National Provider Identifier
1205008935
Registry record updated Feb 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
73105 Issued in GA
Practice address
65 Old Jackson Rd
McDonough, GA 30252-3095
Phone
(678) 490-0080
Fax
(678) 490-0091
NPI assigned
Apr 2, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2015

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 0101245534 VA
Internal Medicine Physician 207R00000X 73105 GA Primary

Addresses

Primary practice location

65 Old Jackson Rd
McDonough, GA 30252-3095

Mailing address

65 Old Jackson Rd
McDonough, GA 30252-3095
Phone (678) 490-0080

Other identifiers 1

IdentifierTypeStateIssuer
1205008935MedicaidVA

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
I20150501001008 GA Practitioner - Internal Medicine 6103979117 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Zam Zam Family Clinic LLCGroup PAC ID 4981930872, 3 clinicians

Practice addresses (Care Compare)

965 Oakland Rd
Lawrenceville, GA 30044-3758
Phone (470) 818-8607

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
73105GAMDInternal Medicine Physician
0101245534VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Zam Zam Family Clinic LLC Internal Medicine CurrentSince Apr 9, 2019 Accepting new patients
Aylo Health, LLC Family Medicine Past Accepting new patients
Aylo Health, LLC Family Medicine Past Accepting new patients
Aylo Health, LLC Family Medicine Past Accepting new patients
Aylo Health, LLC Past Accepting new patients

Locations

965 Oakland Rd
Ste 3E
Lawrenceville, GA 30044
Phone (470) 818-8607

965 Oakland Rd
Ste D
Lawrenceville, GA 30044

965 Oakland Rd
Ste 3D
Lawrenceville, GA 30044
Phone (770) 495-9775

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424649600000",
    "number": "1205008935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 OLD JACKSON RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302523095",
            "telephone_number": "678-490-0080",
            "fax_number": "678-490-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 OLD JACKSON RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302523095",
            "telephone_number": "678-490-0080",
            "fax_number": "678-490-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHATTI",
        "first_name": "SAMINA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-02",
        "last_updated": "2015-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101245534",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "73105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205008935",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McDonough, GA

Sources for this page

Verify at the official NPI Registry.