NPIMap

Individual provider Active NPI

Mehrdod Ehteshami, D.O.

  • Family Medicine Physician
  • Columbus, GA
National Provider Identifier
1659692986
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
67010 Issued in GA
Practice address
1800 10TH Ave
Columbus, GA 31901-1513
Phone
(706) 571-1120
Fax
(706) 571-1603
NPI assigned
Jun 22, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 067010 GA
Family Medicine Physician 207Q00000X 67010 GA Primary

Addresses

Primary practice location

1800 10TH Ave
Columbus, GA 31901-1513

Mailing address

PO Box 1038
Columbus, GA 31902-1038
Phone (706) 571-1120

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
I20141115000185 GA Practitioner - Emergency MedicinePractitioner - Family Practice 7719111061 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Family Practice
Education
Philadelphia College of Osteopathic Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hightower Emergency Group PCGroup PAC ID 3577825751, 29 clinicians

Practice addresses (Care Compare)

801 W Gordon St
Thomaston, GA 30286-3426
Phone (706) 647-8111

Hospital & facility affiliations

  • Upson Regional Medical Center Hospital, Thomaston, GA, CCN 110002

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
67010GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Walker Lake Emergency Group, PC Emergency Medicine CurrentSince Apr 3, 2019 Accepting new patients
Fort Oglethorpe Emergency Physicians Group LLC Emergency Medicine CurrentSince Apr 1, 2026 Accepting new patients
Lagrange Emergency Physicians, LLC Emergency Medicine CurrentSince Jul 10, 2014 Accepting new patients
Emergency Coverage, LLC Emergency Medicine CurrentSince Nov 1, 2017 Accepting new patients
Hightower Emergency Group, PC Emergency Medicine CurrentSince Feb 28, 2022 Accepting new patients
Lavender Inpatient Services LLC Past Accepting new patients
Southland Medical Solutions of Eufaula, PL Emergency Medicine Past Accepting new patients

Locations

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

1200 Memorial Dr
Dalton, GA 30720
Phone (706) 272-6115

1514 Vernon Rd
Lagrange, GA 30240
Phone (706) 812-2369

801 W Gordon St
Thomaston, GA 30286
Phone (706) 647-4371

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 8

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 1

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": "1277164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1659692986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1038",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319021038",
            "telephone_number": "706-571-1120",
            "fax_number": "706-571-1603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 10TH AVE",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319011513",
            "telephone_number": "706-571-1120",
            "fax_number": "706-571-1603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHTESHAMI",
        "first_name": "MEHRDOD",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-22",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "067010",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "67010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

Verify at the official NPI Registry.