Individual provider Active NPI

Mohan Punja, M.D.

  • Emergency Medicine Physician
  • Greenville, NC
National Provider Identifier
1760645543
Registry record updated Mar 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2013-01399 Issued in NC
Practice address
600 Moye Blvd
Ecu Physicians Emergency Medicine
Greenville, NC 27834-4300
Phone
(252) 744-4757
Fax
(252) 744-4125
NPI assigned
Jul 2, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 65878 GA
Emergency Medicine Physician 207P00000X 2013-01399 NC Primary

Addresses

Primary practice location

600 Moye Blvd
Ecu Physicians Emergency Medicine
Greenville, NC 27834-4300

Mailing address

PO Box 751069
Charlotte, NC 28275-1069

Other identifiers 2

IdentifierTypeStateIssuer
1760645543MedicaidNC
179X3OtherNCBCBSNC

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
I20110621000506 GA Practitioner - Emergency Medicine 9537347505 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Virginia School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multispecialty Services LLCGroup PAC ID 8820376080, 2 clinicians

Practice addresses (Care Compare)

3950 Austell Rd
Austell, GA 30106-1121
Phone (470) 732-4000

677 Church St NE
Marietta, GA 30060-1101
Phone (770) 793-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2013-01399NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Coverage, LLC Emergency Medicine CurrentSince Jul 1, 2016 Accepting new patients
Lagrange Emergency Physicians, LLC Emergency Medicine CurrentSince Oct 1, 2020 Accepting new patients
Multispecialty Services, LLC CurrentSince Sep 1, 2016 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Jan 15, 2021 Accepting new patients
Georgia Emergency Group, LLC Emergency Medicine CurrentSince Oct 1, 2020 Accepting new patients
The Bortolazzo Group, LLC Emergency Medicine CurrentSince Mar 5, 2016 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
North Fulton Emergency Physicians, LLC Emergency Medicine CurrentSince Oct 1, 2020 Accepting new patients

Locations

303 Parkway Dr NE
Atlanta, GA 30312
Phone (404) 265-4000

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

1200 Memorial Dr
Dalton, GA 30720
Phone (706) 272-6115

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

1170 Cleveland Ave
East Point, GA 30344
Phone (404) 305-3500

601 S 8th St
Griffin, GA 30224
Phone (770) 228-2721

1050 McDonough Rd
Jackson, GA 30233
Phone (770) 775-7861

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

1514 Vernon Rd
Lagrange, GA 30240
Phone (706) 812-2369

677 Church St NE
Marietta, GA 30060
Phone (770) 793-5435

3000 Hospital Blvd
Roswell, GA 30076
Phone (770) 751-2500

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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 1

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": "1214956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395878400000",
    "number": "1760645543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751069",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MOYE BLVD",
            "address_2": "ECU PHYSICIANS EMERGENCY MEDICINE",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278344300",
            "telephone_number": "252-744-4757",
            "fax_number": "252-744-4125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUNJA",
        "first_name": "MOHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-02",
        "last_updated": "2014-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "65878",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2013-01399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760645543",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "179X3",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.