Individual provider Active NPI

Johnathon J Rast

  • Internal Medicine Physician
  • Augusta, GA
National Provider Identifier
1750067633
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
15210 Issued in GA
Practice address
1120 15TH Street Bi 5070
Augusta, GA 30912
Phone
(706) 721-2423
NPI assigned
Jun 26, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 15210 GA Primary

Addresses

Primary practice location

1120 15TH Street Bi 5070
Augusta, GA 30912

Mailing address

922 Burlington Dr
Evans, GA 30809
Phone (678) 527-9153

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230721000271 GA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 4789044892

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15210GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
August University - Medical College of Georgia Internal Medicine CurrentSince Jul 2, 2023 Accepting new patients

Locations

1120 15th St
#5070
Augusta, GA 30912
Phone (706) 721-2423

Organizations & group practices 1

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": "1687737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1750067633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "922 BURLINGTON DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "30809",
            "telephone_number": "678-527-9153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 15TH STREET BI 5070",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "30912",
            "telephone_number": "706-721-2423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAST",
        "first_name": "JOHNATHON",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "15210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.