Infectious Diseases & International Medicine LLC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

INFECTIOUS DISEASES & INTERNATIONAL MEDICINE LLC

Practice address

1514 Vernon Rd
Lagrange, GA 30240-4131

Phone

(708) 489-9005

Fax

(844) 443-3963

NPI assigned

Jul 8, 2021

Last updated

Mar 23, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nisha Panicker Aravindakshan PatelNPI 1942527478

Title

Ceo/Owner

Phone

(516) 447-0795

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nisha Panicker Aravindakshan Patel, MD, MPH

  • Infectious Disease Physician
  • Lagrange, GA
  • NPI 1942527478
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1265003347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "543 WINTON TER NE UNIT A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082826",
            "telephone_number": "516-424-0795",
            "fax_number": "844-443-3963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 VERNON RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404131",
            "telephone_number": "708-489-9005",
            "fax_number": "844-443-3963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFECTIOUS DISEASES & INTERNATIONAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-08",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "ARAVINDAKSHAN PATEL",
        "authorized_official_first_name": "NISHA",
        "authorized_official_middle_name": "PANICKER",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "516-447-0795",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1942527478",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.",
            "affiliation": "N",
            "endpointDescription": "emedicalpractice.com",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "EMR system",
            "address_1": "543 Winton Ter NE Unit A",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303082826",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.wellstar.org",
            "affiliation": "Y",
            "endpointDescription": "website",
            "affiliationName": "WellStar Medical Group, LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1514 Vernon Rd",
            "city": "LaGrange",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302404131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Infectious Disease Physician in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Infectious Disease Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; 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.

Verify at the official NPI Registry.