NPIMap

Individual provider Active NPI

Nimisha J Trivedi, MD

  • Family Medicine Physician
  • Locust Grove, GA
National Provider Identifier
1629074299
Registry record updated Sep 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
053715 Issued in GA
Practice address
3778 Highway 42
Locust Grove, GA 30248
Phone
(678) 610-6649
Fax
(678) 610-6025
NPI assigned
Jun 28, 2005
Reactivated
Mar 23, 2006
Last updated
Sep 15, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X 053715 GA
Family Medicine Physician 207Q00000X 053715 GA Primary

Addresses

Primary practice location

3778 Highway 42
Locust Grove, GA 30248

Mailing address

3778 Highway 42
Locust Grove, GA 30248
Phone (678) 610-6649

Other identifiers 1

IdentifierTypeStateIssuer
117518856AMedicaidGA

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
I20040420000918 GA Practitioner - Family Practice 2668467622 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1996
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Matrix Rehabilitation-Georgia IncGroup PAC ID 2567379498, shared by 4 NPIs, 40 clinicians
Locust Grove Family MedicineGroup PAC ID 1052306008, 5 clinicians

Practice addresses (Care Compare)

234 Jonesboro Rd
McDonough, GA 30253-3720
Phone (770) 954-9631

3778 Hwy 42
Locust Grove, GA 30248
Phone (678) 610-6649

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
053715GAMDUrgent Care Clinic/Center

Practice roles

OrganizationSpecialtyStatusNew patients
Sushrut LLC Family Medicine CurrentSince Aug 25, 2024 Accepting new patients
Medlife Healthcare LLC Family Medicine Current Accepting new patients
Sushrut LLC Family Medicine Current Accepting new patients
Reliance Family Care Family Medicine Past Accepting new patients

Locations

3778 Highway 42 S
Locust Grove, GA 30248
Phone (678) 610-6649

Organizations & group practices 5

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 4

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": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473897600000",
    "number": "1629074299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3778 HIGHWAY 42",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "30248",
            "telephone_number": "678-610-6649",
            "fax_number": "678-610-6025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3778 HIGHWAY 42",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "30248",
            "telephone_number": "678-610-6649",
            "fax_number": "678-610-6025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIVEDI",
        "first_name": "NIMISHA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-28",
        "last_updated": "2016-09-15",
        "deactivation_date": "2006-03-17",
        "reactivation_date": "2006-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "GA",
            "license": "053715",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "053715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117518856A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Locust Grove, GA

Sources for this page

Verify at the official NPI Registry.