Active NPI
Reagan Medical Center
- Neurological Surgery Physician
- Roswell, GA
National Provider Identifier
1457968372
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
- 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
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.
National Provider Directory
National Provider Directory- Part of
- Reagan Medical Center LLC
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.