NPIMap

Organization Active NPI

Prime Regen Decatur

  • Rheumatology Physician
  • Decatur, GA
National Provider Identifier
1811668593
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
Legal business name
PRIME REGEN DECATUR
Practice address
2680 Lawrenceville Hwy Ste 101
Decatur, GA 30033-2526
Phone
(470) 292-3820
NPI assigned
Sep 23, 2021
Last updated
Oct 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Authorized official

Name
Mr. Randall Lee Haupt, MHA
Title
Executive Vice President, Sgi
Phone
(470) 292-3820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X NU Primary

Addresses

Primary practice location

2680 Lawrenceville Hwy Ste 101
Decatur, GA 30033-2526

Mailing address

2680 Lawrenceville Hwy Ste 101
Decatur, GA 30033-2526
Phone (470) 292-3820

Other names 1

  • Prime Regen Decatur LLC Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rhaupt@primeregen.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211201000500 GA Part B Supplier - Clinic/Group Practice 3274923503 Receives reassigned benefits from 11 practitioners
Practice locations: Decatur, GA

National Provider Directory

National Provider Directory

Locations

4181 Pleasant Hill Rd
Ste 150
Duluth, GA 30096
Phone (470) 292-3820

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1632355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1811668593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 LAWRENCEVILLE HWY STE 101",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300332526",
            "telephone_number": "470-292-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 LAWRENCEVILLE HWY STE 101",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300332526",
            "telephone_number": "470-292-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME REGEN DECATUR",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-23",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "HAUPT",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT, SGI",
        "authorized_official_telephone_number": "470-292-3820",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rhaupt@primeregen.com",
            "affiliation": "N",
            "endpointDescription": "rhaupt@primeregen.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2680 Lawrenceville Hwy Ste 101",
            "city": "Decatur",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300332526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Prime Regen Decatur LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Prime Regen Decatur LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; 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.

Verify at the official NPI Registry.