NPIMap

Organization Active NPI

Locust Grove Family Medicine

  • Non-Pharmacy Dispensing Site
  • Locust Grove, GA
National Provider Identifier
1629169164
Registry record updated Mar 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
053715 Issued in GA
Legal business name
LOCUST GROVE FAMILY MEDICINE
Practice address
3778 Highway 42
Locust Grove, GA 30248-3632
Phone
(678) 610-6649
Fax
(678) 610-6025
NPI assigned
Sep 28, 2006
Last updated
Mar 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2016

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

Authorized official

Name
Dr. Nimisha J Trivedi, MDNPI 1629074299
Title
Owner
Phone
(678) 610-6649

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 053715 GA
Non-Pharmacy Dispensing Site 332900000X 053715 GA Primary

Addresses

Primary practice location

3778 Highway 42
Locust Grove, GA 30248-3632

Mailing address

3778 Highway 42
Locust Grove, GA 30248-3632
Phone (678) 610-6649

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040419000601 GA Part B Supplier - Clinic/Group Practice 1052306008 Receives reassigned benefits from 7 practitioners
Practice locations: Locust Grove, GA; McDonough, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1017382Locust Grove Family Medicine PC3778 Highway 42, Locust Grove, GA 30248Provider-performed microscopySep 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Locust Grove Family Medicine3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19518/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/GDIGDD

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 7

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": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457913600000",
    "number": "1629169164",
    "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": "302483632",
            "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": "302483632",
            "telephone_number": "678-610-6649",
            "fax_number": "678-610-6025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOCUST GROVE FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2016-03-14",
        "status": "A",
        "authorized_official_last_name": "TRIVEDI",
        "authorized_official_first_name": "NIMISHA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-610-6649",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "053715",
            "primary": false
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "GA",
            "license": "053715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Locust Grove, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.