Individual provider Active NPI

Sudhindra K Anegundi, MD

  • Vascular Surgery Physician
  • Lawrenceville, GA
National Provider Identifier
1629039052
Registry record updated Sep 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
017970 Issued in GA
Practice address
631 Professional Drive
Suite 300
Lawrenceville, GA 30046-3371
Phone
(770) 962-9977
Fax
(770) 339-9804
NPI assigned
Mar 28, 2006
Last updated
Sep 1, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 017970 GA Primary

Addresses

Primary practice location

631 Professional Drive
Suite 300
Lawrenceville, GA 30046-3371

Mailing address

631 Professional Drive
Suite 300
Lawrenceville, GA 30046-3371
Phone (770) 962-9977

Other identifiers 1

IdentifierTypeStateIssuer
000363998FMedicaidGA

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
I20060502000493 GA Practitioner - General Surgery 4688684814 Reassigns benefits to 1 organization
Practice locations: Lawrenceville, GA

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
017970GAMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gwinnett Surgical Specialists Professional Services, LLC CurrentSince Sep 3, 2019 Accepting new patients
Wallace F. Martin, M.D. Past Accepting new patients
Gwinnett Clinic LTD Past Accepting new patients
Charles B Moomey Jr MD Vascular Surgery Past Accepting new patients

Locations

631 Professional Dr
Ste 300
Lawrenceville, GA 30046
Phone (770) 962-9977

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.

NPI Registry JSON

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283299200000",
    "number": "1629039052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 PROFESSIONAL DRIVE",
            "address_2": "SUITE 300",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463371",
            "telephone_number": "770-962-9977",
            "fax_number": "770-339-9804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 PROFESSIONAL DRIVE",
            "address_2": "SUITE 300",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463371",
            "telephone_number": "770-962-9977",
            "fax_number": "770-339-9804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANEGUNDI",
        "first_name": "SUDHINDRA",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2010-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "GA",
            "license": "017970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000363998F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.