Organization Active NPI

Regional Infectious Diseases and Infusion Center Inc

  • Infectious Disease Physician
  • Lagrange, GA
National Provider Identifier
1285220749
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
REGIONAL INFECTIOUS DISEASES AND INFUSION CENTER INC
Practice address
505 Jenkins St
Lagrange, GA 30240-4225
Phone
(706) 739-7789
Fax
(706) 739-7776
NPI assigned
Dec 17, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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

Authorized official

Name
Bhuvan Doneepudi
Title
Executive Director
Phone
(248) 513-2425

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0200X Primary

Addresses

Primary practice location

505 Jenkins St
Lagrange, GA 30240-4225

Mailing address

505 Jenkins St
Lagrange, GA 30240-4225
Phone (706) 739-7789

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201229003000 GA Part B Supplier - Clinic/Group Practice 2264445006 Receives reassigned benefits from 2 practitioners
Practice locations: Lagrange, GA

National Provider Directory

National Provider Directory

Locations

505 Jenkins St
Lagrange, GA 30240
Phone (706) 407-0161

2101 Newnan Crossing Blvd E
Newnan, GA 30265
Phone (678) 552-6200

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1608163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695168000000",
    "number": "1285220749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 JENKINS ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404225",
            "telephone_number": "706-739-7789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 JENKINS ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404225",
            "telephone_number": "706-739-7789",
            "fax_number": "706-739-7776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL INFECTIOUS DISEASES AND INFUSION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-17",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A",
        "authorized_official_last_name": "DONEEPUDI",
        "authorized_official_first_name": "BHUVAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "248-513-2425"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; 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.