NPIMap

Organization Active NPI

Restore First Health Riverdale LLC

  • Rheumatology Physician
  • Riverdale, GA
National Provider Identifier
1497439509
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
Legal business name
RESTORE FIRST HEALTH RIVERDALE LLC
Practice address
34 Upper Riverdale Rd SE Ste 101
Riverdale, GA 30274-2635
Phone
(470) 292-3820
Fax
(470) 280-9511
NPI assigned
Jun 12, 2023
Last updated
Oct 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Authorized official

Name
Randall Lee Haupt, MHA
Title
Executive Vice President, Sgi
Phone
(931) 494-7057

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RR0500X Primary

Addresses

Primary practice location

34 Upper Riverdale Rd SE Ste 101
Riverdale, GA 30274-2635

Mailing address

10680 Medlock Bridge Rd Ste 101
Johns Creek, GA 30097-8420
Phone (470) 292-3820

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240202002052 GA Part B Supplier - Clinic/Group Practice 5890141550 Receives reassigned benefits from 11 practitioners
Practice locations: Riverdale, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1497439509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10680 MEDLOCK BRIDGE RD STE 101",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300978420",
            "telephone_number": "470-292-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 UPPER RIVERDALE RD SE STE 101",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742635",
            "telephone_number": "470-292-3820",
            "fax_number": "470-280-9511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE FIRST HEALTH RIVERDALE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-12",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "HAUPT",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT, SGI",
        "authorized_official_telephone_number": "931-494-7057",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; 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.