NPIMap

Individual provider Active NPI

Don R Connell, M.D.

  • Diagnostic Radiology Physician
  • Rincon, GA
National Provider Identifier
1740282003
Registry record updated Sep 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
020680 Issued in GA
Practice address
112 Lake Tomacheechee Dr
Rincon, GA 31326-5117
Phone
(912) 826-7310
Fax
(912) 826-7310
NPI assigned
Jun 1, 2005
Reactivated
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 020680 GA Primary

Addresses

Primary practice location

112 Lake Tomacheechee Dr
Rincon, GA 31326-5117

Mailing address

112 Lake Tomacheechee Dr
Rincon, GA 31326-5117
Phone (912) 826-7310

Other identifiers 2

IdentifierTypeStateIssuer
00232889HMedicaidGA
GRP 2523OtherGAMEDICARE PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10639SCMDPediatric Dentist
020680GAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Statesboro Imaging Center, P.C. CurrentSince Aug 1, 1991 Accepting new patients
Statesboro Imaging Center, P.C. Current Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379462400000",
    "number": "1740282003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 LAKE TOMACHEECHEE DR",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313265117",
            "telephone_number": "912-826-7310",
            "fax_number": "912-826-7310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 LAKE TOMACHEECHEE DR",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313265117",
            "telephone_number": "912-826-7310",
            "fax_number": "912-826-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELL",
        "first_name": "DON",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2013-09-18",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "020680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00232889H",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "GRP 2523",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rincon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.