Individual provider Active NPI

Mailupillai Kumareswaran, MD

  • Internal Medicine Physician
  • Lawrenceville, GA
National Provider Identifier
1487603262
Registry record updated Jan 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
045861 Issued in GA
Practice address
475 Philip Blvd Ste 300
Lawrenceville, GA 30046-8736
Phone
(770) 995-3300
Fax
(770) 995-3307
NPI assigned
May 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 045861 GA Primary

Addresses

Primary practice location

475 Philip Blvd Ste 300
Lawrenceville, GA 30046-8736

Mailing address

10600 Medlock Bridge Rd
Duluth, GA 30097-8404

Other practice location 1

2327 Winder Hwy
Dacula, GA 30019-2205
Phone (770) 962-0054

Other practice location 2

4580 Nelson Brogdon Blvd
Buford, GA 30518-3478
Phone (770) 831-6703

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110823000654 GA Practitioner - Internal Medicine 6204006661 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gwinnett Clinic, LTDGroup PAC ID 9436061801, 44 clinicians

Practice addresses (Care Compare)

475 Philip Blvd
Suite 300
Lawrenceville, GA 30046-8736
Phone (777) 099-5330

Hospital & facility affiliations

  • Central Home Health Care, an Amedisys Company Home health agency, Tucker, GA, CCN 117026
  • Centerwell Home Health Home health agency, Kennesaw, GA, CCN 117027
  • Accentcare Home Health of Northeast Georgia Home health agency, Buford, GA, CCN 117139
  • Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087
  • Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Gwinnett Clinic LTD Current Accepting new patients
Gwinnett Clinic, LTD Internal Medicine CurrentSince Sep 15, 1998 Accepting new patients
Gwinnett Clinic, LTD Internal Medicine CurrentSince Sep 15, 1998 Accepting new patients

Locations

4580 Nelson Brogdon Blvd
Buford, GA 30518
Phone (770) 831-6703

2327 Winder Hwy
Dacula, GA 30019
Phone (770) 962-0054

10600 Medlock Bridge Rd
Johns Creek, GA 30097
Phone (770) 418-0818

475 Philip Blvd
Ste 100301
Lawrenceville, GA 30046
Phone (770) 923-7301

475 Philip Blvd
Ste 100
Lawrenceville, GA 30046
Phone (678) 226-6202

475 Philip Blvd
Ste 300
Lawrenceville, GA 30046

Interoperability endpoints

  • Direct secure messaging: mailupillai.kumareswaran@gclinic.emedpractice.direct-ci.com
  • Direct secure messaging: mailupillai.kumareswaran.1@32352.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673654400000",
    "number": "1487603262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10600 MEDLOCK BRIDGE RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300978404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 PHILIP BLVD STE 300",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468736",
            "telephone_number": "770-995-3300",
            "fax_number": "770-995-3307"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2327 Winder Hwy",
            "address_purpose": "LOCATION",
            "city": "Dacula",
            "state": "GA",
            "postal_code": "300192205",
            "country_code": "US",
            "telephone_number": "770-962-0054",
            "fax_number": "770-962-1747",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4580 Nelson Brogdon Blvd",
            "address_purpose": "LOCATION",
            "city": "Buford",
            "state": "GA",
            "postal_code": "305183478",
            "country_code": "US",
            "telephone_number": "770-831-6703",
            "fax_number": "770-831-6705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUMARESWARAN",
        "first_name": "MAILUPILLAI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2023-01-14",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "045861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.