NPIMap

Individual provider Active NPI

Dinesh Venkoba Raju, MD, PHD

  • Neurology Physician
  • Lawrenceville, GA
National Provider Identifier
1548465198
Registry record updated Jan 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
065880 Issued in GA
Practice address
475 Philip Blvd Ste 200
Lawrenceville, GA 30046-8737
Phone
(678) 226-6201
Fax
(678) 225-4037
NPI assigned
Jun 15, 2007
Last updated
Jan 14, 2023By the provider in NPPES
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 065880 GA Primary
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X 065880 GA

Addresses

Primary practice location

475 Philip Blvd Ste 200
Lawrenceville, GA 30046-8737

Mailing address

10600 Medlock Bridge Rd
Duluth, GA 30097-8404

Other identifiers 1

IdentifierTypeStateIssuer
003119067MedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120123000423 GA Practitioner - Neurology 4587831151 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Emory University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Esop Rehabilitation LLCGroup PAC ID 9739305749, shared by 9 NPIs, 224 clinicians
Gwinnett Clinic, LTDGroup PAC ID 9436061801, 44 clinicians

Practice addresses (Care Compare)

1699 Hwy 124 N
Suite 100
Snellville, GA 30078-7921
Phone (678) 218-6702

475 Philip Blvd
Lawrenceville, GA 30046-8736

475 Philip Blvd
Lawrenceville, GA 30046-8737

Hospital & facility affiliations

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, Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Gwinnett Clinic, LTD CurrentSince Jan 1, 2012 Accepting new patients
Gwinnett Clinic, LTD Neurology CurrentSince Jan 1, 2012 Accepting new patients
Gwinnett Clinic LTD Current Accepting new patients
Gwinnett Clinic, LTD Past Accepting new patients

Locations

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

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

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

475 Philip Blvd
Ste 200
Lawrenceville, GA 30046
Phone (678) 226-6201

Interoperability endpoints

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

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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": "1181865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673654400000",
    "number": "1548465198",
    "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 200",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468737",
            "telephone_number": "678-226-6201",
            "fax_number": "678-225-4037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJU",
        "first_name": "DINESH",
        "middle_name": "VENKOBA",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-15",
        "last_updated": "2023-01-14",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "065880",
            "primary": true
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "GA",
            "license": "065880",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003119067",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.