Individual provider Active NPI

Jay Desai

  • Vascular & Interventional Radiology Physician
  • Marietta, GA
National Provider Identifier
1750580189
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
87784 Issued in GA
Practice address
790 Church St NE Ste 400
Marietta, GA 30060-8957
Phone
(700) 405-2976
Fax
(700) 988-0730
NPI assigned
Jul 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 87784 GA
Vascular & Interventional Radiology Physician 2085R0204X 87784 GA Primary

Addresses

Primary practice location

790 Church St NE Ste 400
Marietta, GA 30060-8957

Mailing address

PO Box 3157
Indianapolis, IN 46206-3157
Phone (700) 405-2976

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20131121001885 CA Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 6507092509 Reassigns benefits to 1 organization
I20210422001625 GA Practitioner - Diagnostic Radiology 6507092509 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Emory University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Quantum Radiology PCGroup PAC ID 4385543230, 105 clinicians

Practice addresses (Care Compare)

790 Church St NE
Suite 400
Marietta, GA 30060-8957
Phone (770) 952-8899

Hospital & facility affiliations

  • Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035
  • Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143
  • Wellstar Paulding Medical Center Hospital, Hiram, GA, CCN 110042
  • Wellstar North Fulton Medical Center Hospital, Roswell, GA, CCN 110198
  • Wellstar Douglas Medical Center Hospital, Douglasville, GA, CCN 110184

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
87784GAMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
M & B Imaging, PC Diagnostic Radiology CurrentSince May 17, 2021 Accepting new patients
Quantum Radiology, PC Diagnostic Radiology CurrentSince Apr 1, 2021 Accepting new patients
Synergy Radiology, LLC Diagnostic Radiology CurrentSince May 8, 2021 Accepting new patients
Permanente Medical Group Inc Internal Medicine Current Accepting new patients
Synergy Radiology, LLC CurrentSince May 8, 2021 Accepting new patients
Permanente Medical Group Inc Internal Medicine CurrentSince Aug 24, 2013 Accepting new patients
Permanente Medical Group, Inc CurrentSince Aug 24, 2013 Accepting new patients

Locations (25 of 66)

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

250 Hospital Pkwy
San Jose, CA 95119
Phone (408) 972-6320

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

4550 Cobb Parkway North NW
Ste 109
Acworth, GA 30101
Phone (470) 956-0079

2450 Old Milton Pkwy
Alpharetta, GA 30009
Phone (470) 267-0360

12460 Crabapple Rd
Alpharetta, GA 30004
Phone (678) 762-0574

5655 Atlanta Hwy
Alpharetta, GA 30004
Phone (770) 691-0819

3730 Carmia Dr SW
Ste 110
Atlanta, GA 30331
Phone (404) 344-7286

3890 Redwine Rd SW
Ste 104
Atlanta, GA 30331
Phone (404) 629-4700

1625 Hospital North Dr
Austell, GA 30106
Phone (770) 732-6950

1025 E West Connector
Ste 520
Austell, GA 30106
Phone (678) 273-3071

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

1680 Hospital South Dr
Austell, GA 30106
Phone (678) 945-2100

1501 Milstead Rd NE
Ste 140
Conyers, GA 30012

925 Sanders Rd
Cumming, GA 30041
Phone (404) 567-6500

120 Greystone Power Blvd
Dallas, GA 30157
Phone (470) 267-1540

6002 Professional Pkwy
Ste 260
Douglasville, GA 30134
Phone (470) 644-5411

8954 Hospital Dr
Douglasville, GA 30134
Phone (678) 838-2584

6001 Professional Pkwy
Douglasville, GA 30134
Phone (404) 274-7335

4244 Washington Rd
Evans, GA 30809
Phone (706) 619-1869

307 W Robinson Ave
Grovetown, GA 30813

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 5

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": "1184544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1750580189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3157",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462063157",
            "telephone_number": "700-405-2976",
            "fax_number": "700-988-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 CHURCH ST NE STE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608957",
            "telephone_number": "700-405-2976",
            "fax_number": "700-988-0730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESAI",
        "first_name": "JAY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-16",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "87784",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "GA",
            "license": "87784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "250 Hospital Pkwy",
            "city": "San Jose",
            "state": "CA",
            "country_code": "US",
            "postal_code": "951191103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.