NPIMap

Organization Active NPI

Reagan Medical Center

  • Family Medicine Physician
  • Suwanee, GA
National Provider Identifier
1649365750
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
048008 Issued in GA
Legal business name
REAGAN MEDICAL CENTER
Practice address
2696 Lawrenceville Suwanee Rd
Suwanee, GA 30024-2535
Phone
(770) 771-5570
Fax
(770) 771-5571
NPI assigned
Oct 4, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Sean Bartlett Herrin, M.D.
Title
Physician
Phone
(678) 654-3665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 048008 GA Primary

Addresses

Primary practice location

2696 Lawrenceville Suwanee Rd
Suwanee, GA 30024-2535

Mailing address

2696 Lawrenceville Suwanee Rd
Suwanee, GA 30024-2535
Phone (770) 771-5570

Other identifiers 1

IdentifierTypeStateIssuer
1861412629OtherNPI

Other names 1

  • REAGAN MEDICAL CENTER IN SUWANEE Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000573 GA Part B Supplier - Clinic/Group Practice 6507779329 Receives reassigned benefits from 55 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawrenceville, GA; Suwanee, GA; Johns Creek, GA; Dacula, GA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

771 Old Norcross Rd
Ste 310
Lawrenceville, GA 30046
Phone (770) 513-5999

5354 Lawrenceville Hwy NW
Lilburn, GA 30047
Phone (770) 493-1800

Practitioners & affiliated clinicians

Practitioners 2

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": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1649365750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2696 LAWRENCEVILLE SUWANEE RD",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242535",
            "telephone_number": "770-771-5570",
            "fax_number": "770-771-5571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2696 LAWRENCEVILLE SUWANEE RD",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242535",
            "telephone_number": "770-771-5570",
            "fax_number": "770-771-5571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REAGAN MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2022-07-21",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "HERRIN",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "BARTLETT",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "678-654-3665",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "048008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1861412629",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REAGAN MEDICAL CENTER IN SUWANEE",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "REAGAN MEDICAL CENTER IN SUWANEE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Suwanee, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.