Active NPI
Reagan Medical Center
- Neurological Surgery Physician
- Bethlehem, GA
National Provider Identifier
1699388231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurological Surgery Physician
- Legal business name
- REAGAN MEDICAL CENTER
- Practice address
- 426 Exchange Blvd Ste 500
Bethlehem, GA 30620-1797 - Phone
- (678) 999-2299
- NPI assigned
- Aug 24, 2020
- Organization subpart
- Yes
- Parent organization
- REAGAN MEDICAL CENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Satish B Poddar, MD
- Title
- MD
- Phone
- (678) 344-8700
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | |||
| Neurological Surgery Physician | 207T00000X | Primary | ||
| Urgent Care Clinic/Center | 261QU0200X |
Addresses
Primary practice location
426 Exchange Blvd Ste 500
Bethlehem, GA 30620-1797
Mailing address
2878 Five Forks Trickum Rd Ste 2a
Lawrenceville, GA 30044-5896
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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- Part of
- Reagan Medical Center LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598227200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598400000000",
"number": "1699388231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2878 FIVE FORKS TRICKUM RD STE 2A",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300445896"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "426 EXCHANGE BLVD STE 500",
"city": "BETHLEHEM",
"state": "GA",
"postal_code": "306201797",
"telephone_number": "678-999-2299"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REAGAN MEDICAL CENTER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "REAGAN MEDICAL CENTER",
"enumeration_date": "2020-08-24",
"last_updated": "2020-08-26",
"certification_date": "2020-08-26",
"status": "A",
"authorized_official_last_name": "PODDAR",
"authorized_official_first_name": "SATISH",
"authorized_official_middle_name": "B",
"authorized_official_title_or_position": "MD",
"authorized_official_telephone_number": "678-344-8700",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207T00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Neurological Surgery",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bethlehem, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; 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.