NPIMap

Individual provider Active NPI

Justin Pandoo, MD

  • Internal Medicine Physician
  • Conway, SC
National Provider Identifier
1659755361
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
61237 Issued in SC
Practice address
2367B Cypress Cir
Conway, SC 29526-8921
Phone
(843) 349-1001
Fax
(843) 349-1008
NPI assigned
Jul 13, 2015
Last updated
Nov 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 97887 GA
Internal Medicine Physician 207R00000X 61237 SC Primary

Addresses

Primary practice location

2367B Cypress Cir
Conway, SC 29526-8921

Mailing address

300 Singleton Ridge Road
Attention Patient Accounting
Conway, SC 29526-9142
Phone (843) 234-6946

Other practice location 1

827 Linden Ave
Baltimore, MD 21201-4606
Phone (410) 225-8790

Other practice location 2

1240 Jesse Jewell Pkwy SE Ste 500
Gainesville, GA 30501-3861
Phone (770) 536-9864

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
I20231120001056 GA Practitioner - Internal Medicine 1052614534 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northeast Georgia Diagnostic Associates and Clinic, LLCGroup PAC ID 1951655737, 81 clinicians

Practice addresses (Care Compare)

1240 Jesse Fewell Pkwy SE
Suite 500
Gainesville, GA 30501-3861
Phone (770) 536-9864

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.26 of 100Reported as group
Quality
71.9
Promoting interoperability
75
Improvement activities
40
Cost
76.47

Merit-based Incentive Payment System (MIPS)

Final score
52.78 of 100Reported as group
Quality
55.48
Improvement activities
0
Cost
74.21

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
97887GAMDInternal Medicine Physician
61237SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Georgia Diagnostic Associates and Clinic, LLC CurrentSince Dec 1, 2023 Accepting new patients
Northeast Georgia Diagnostic Clinic LLC Past Accepting new patients

Locations

1240 Jesse Jewell Pkwy SE
Ste 500
Gainesville, GA 30501

1250 Jesse Jewell Pkwy SE
Ste 400
Gainesville, GA 30501
Phone (770) 532-0800

Interoperability endpoints

  • Direct secure messaging: justinpandoo@negaidx.allscriptsdirect.net

Organizations & group practices 2

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 8

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": "1436745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1659755361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE ROAD",
            "address_2": "ATTENTION PATIENT ACCOUNTING",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142",
            "telephone_number": "843-234-6946",
            "fax_number": "843-234-8958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2367B CYPRESS CIR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268921",
            "telephone_number": "843-349-1001",
            "fax_number": "843-349-1008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "827 Linden Ave",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212014606",
            "country_code": "US",
            "telephone_number": "410-225-8790",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1240 Jesse Jewell Pkwy SE Ste 500",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013861",
            "country_code": "US",
            "telephone_number": "770-536-9864",
            "fax_number": "770-297-5025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PANDOO",
        "first_name": "JUSTIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-13",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "97887",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "61237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

Verify at the official NPI Registry.