Active NPI
Reagan Medical Center
- Neurological Surgery Physician
- Roswell, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurological Surgery Physician
- Legal business name
- REAGAN MEDICAL CENTER
- Practice address
- 1295 Hembree Rd Ste 200
Roswell, GA 30076-5721 - Phone
- (678) 344-8700
- NPI assigned
- Sep 24, 2020
- Last updated
- Sep 24, 2020
- Organization subpart
- Yes
- Parent organization
- REAGAN MEDICAL CENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Satish B Poddar
- Title
- Ceo
- Phone
- (678) 344-8700
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | Primary |
Addresses
Primary practice location
1295 Hembree Rd Ste 200
Roswell, GA 30076-5721
Mailing address
2878 Five Forks Trickum Rd Ste 2a
Lawrenceville, GA 30044-5896
Phone (678) 999-2299
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031107000573 | GA | Part B Supplier - Clinic/Group Practice | 6507779329 |
Receives reassigned benefits from 55 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lawrenceville, GA; Suwanee, GA; Johns Creek, GA; Dacula, GA |
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba hamilton mill medical center
- Specialist
- Dacula, GA
- NPI 1972666253
O20031107000573
National Provider Directory
National Provider Directory- Part of
- Reagan Medical Center
Practitioners & affiliated clinicians
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.
-
- Internal Medicine Physician
- Lawrenceville, GA
- NPI 1083603922
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600905600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1600905600000",
"number": "1457968372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2878 FIVE FORKS TRICKUM RD STE 2A",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300445896",
"telephone_number": "678-999-2299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1295 HEMBREE RD STE 200",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300765721",
"telephone_number": "678-344-8700"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REAGAN MEDICAL CENTER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "REAGAN MEDICAL CENTER",
"enumeration_date": "2020-09-24",
"last_updated": "2020-09-24",
"certification_date": "2020-09-24",
"status": "A",
"authorized_official_last_name": "PODDAR",
"authorized_official_first_name": "SATISH",
"authorized_official_middle_name": "B",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "678-344-8700"
},
"taxonomies": [
{
"code": "207T00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Neurological Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roswell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; 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.