Individual provider Active NPI

Charu Gupta Prakash, M.D.

  • Hospitalist Physician
  • Marietta, GA
National Provider Identifier
1619160397
Registry record updated Oct 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
065300 Issued in GA
Practice address
677 Church St NE # 111
Marietta, GA 30060-1101
Phone
(770) 793-7750
NPI assigned
Aug 25, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 31, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MT188913 PA
Internal Medicine Physician 207R00000X 065300 GA
Hospitalist Physician 208M00000X 065300 GA Primary

Addresses

Primary practice location

677 Church St NE # 111
Marietta, GA 30060-1101

Mailing address

805 Sandy Plains Road
Medical Staff Services
Marietta, GA 30066-6340

Other practice location 1

6468 Terrace Ct
Harrisburg, PA 17111-7028
Phone (717) 651-0408

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cprakash110905@directwellstar.org

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
I20110209001073 GA Practitioner - HospitalistPractitioner - Internal Medicine 2163602053 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

8954 Hospital Dr
Douglasville, GA 30134-2272
Phone (678) 838-2585

Hospital & facility affiliations

  • Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035
  • Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT188913PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
24 On Physicians, P.C. Hospitalist CurrentSince Jan 5, 2011 Accepting new patients
Wellstar Medical Group, LLC Hospitalist CurrentSince Aug 10, 2015 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Aug 10, 2015 Accepting new patients
24 On Physicians, PC Hospitalist CurrentSince Jan 5, 2011 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Kennestone Hospital, Inc. Past Accepting new patients

Locations

13000 Deerfield Pkwy
Ste 100
Alpharetta, GA 30004

1412 Milstead Ave NE
Conyers, GA 30012
Phone (770) 918-3000

8954 Hospital Dr
Douglasville, GA 30134
Phone (678) 838-2584

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230

677 Church St NE
#111
Marietta, GA 30060
Phone (770) 793-7750

805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616

304 Turner McCall Blvd SW
Rome, GA 30165
Phone (706) 506-5000

Interoperability endpoints

  • Direct secure messaging: cprakash110905@directwellstar.org

Organizations & group practices 6

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 2

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": "1188000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572480000000",
    "number": "1619160397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 SANDY PLAINS ROAD",
            "address_2": "MEDICAL STAFF SERVICES",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300666340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 CHURCH ST NE # 111",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601101",
            "telephone_number": "770-793-7750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6468 Terrace Ct",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "PA",
            "postal_code": "171117028",
            "country_code": "US",
            "telephone_number": "717-651-0408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRAKASH",
        "first_name": "CHARU",
        "middle_name": "GUPTA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-25",
        "last_updated": "2019-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT188913",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "065300",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "065300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cprakash110905@directwellstar.org",
            "affiliation": "N",
            "address_1": "677 Church St NE # 111",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300601101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.