Deepa Sanjay Jagdale, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

003071 Issued in GA

Practice address

699 Furys Ferry Rd
Martinez, GA 30907-9064

Phone

(706) 901-7337

Fax

(706) 903-5002

NPI assigned

Jun 25, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• The Pediatric Office, LLC

  • Pediatric Adolescent Medicine Physician
  • Evans, GA
  • NPI 1629025432
  Medicare reassignment NPD
• Csra Health LLC

  • Pediatrics Physician
  • Martinez, GA
  • NPI 1467143313
  NPD Authorized official
• Augusta Pediatric Clinic, PC

  • Pediatrics Physician
  • Augusta, GA
  • NPI 1952486003
  NPD (past)

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1447412184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CSRA PEDS",
            "address_2": "699 FURYS FERRY RD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309073093",
            "telephone_number": "706-901-7337",
            "fax_number": "706-903-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "699 FURYS FERRY RD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309079064",
            "telephone_number": "706-901-7337",
            "fax_number": "706-903-5002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3540 Wheeler Rd Ste 302",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309091898",
            "country_code": "US",
            "telephone_number": "706-737-0111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAGDALE",
        "first_name": "DEEPA",
        "middle_name": "SANJAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-25",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "31458",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "003071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003161963F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "314582",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony Benavente Ishmael Jr.
• J Perry Davis DMD PC
• Eric A Jablonski, DC
• Edith Sinclair Jackson, M.S.W.
• Tiara Y Jackson, RBT
• James C. Sherman MD PC
• Andrea James
• Cornelius Rohaven James Jr., M.D.
• Janogan LLC (Janogan Enhancement Center of Georgia)
• Le'Landra Jarvis

• Pediatrics Physician in Martinez, GA
• Providers in Martinez, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.