NPIMap

Individual provider Active NPI

Hetal P Thakore, MD

  • Internal Medicine Physician
  • Augusta, GA
National Provider Identifier
1821184540
Registry record updated Sep 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
053556 Issued in GA
Practice address
811 13TH Street
Suite 10
Augusta, GA 30901
Phone
(706) 434-1590
Fax
(803) 279-6001
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2013

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 053556 GA
Internal Medicine Physician 207R00000X 053556 GA Primary
Family Medicine Physician 207Q00000X 053556 GA

Addresses

Primary practice location

811 13TH Street
Suite 10
Augusta, GA 30901

Mailing address

811 13TH Street
Suite 10
Augusta, GA 30901
Phone (706) 434-1590

Other identifiers 3

IdentifierTypeStateIssuer
G53556MedicaidSC
442892357DMedicaidGA
52058546-003OtherGABCBS OF GA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070518000194 GA Practitioner - Internal MedicinePractitioner - Family Practice 3476650821 Reassigns benefits to 2 organizations
I20130911000900 SC Practitioner - Internal MedicinePractitioner - Emergency Medicine 3476650821 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Family Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minaxi LLCGroup PAC ID 0840598207, 3 clinicians

Practice addresses (Care Compare)

1537 Walton Way
Augusta, GA 30904-3764
Phone (706) 731-1300

350 Austin Graybill Rd
North Augusta, SC 29860-9251
Phone (703) 750-8064

3524 Lost Tree CT
Martinez, GA 30907-9500
Phone (706) 267-7681

3651 Wheeler Rd
Augusta, GA 30909-6521
Phone (706) 651-6160

Hospital & facility affiliations

  • Doctors Hospital Hospital, Augusta, GA, CCN 110177
  • Wellstar MCG Health, Affiliated With Med Col Hospital, Augusta, GA, CCN 110034
  • Piedmont Augusta Hospital Hospital, Augusta, GA, CCN 110028
  • Aiken Regional Medical Center Hospital, Aiken, SC, CCN 420082
  • Doctors Hospital Inpatient rehabilitation facility, Augusta, GA, CCN 11T177
  • Select Specialty Hospital - Augusta, Inc Long-term care hospital, Augusta, GA, CCN 112013
  • Harborview Health Center of Augusta Nursing home, Augusta, GA, CCN 115291

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Physician Services - Southeast Professional Corporation Hospitalist CurrentSince Sep 11, 2019 Accepting new patients
Minaxi, LLC Family Medicine CurrentSince Mar 1, 2016 Accepting new patients
Southeast Psych Services LLC PastSince Apr 1, 2021 Accepting new patients
Palmetto Psych Services LLC PastSince Nov 5, 2020 Accepting new patients
Walton Innovations Inc. Past Accepting new patients
Minaxi, LLC Internal Medicine PastSince Jun 14, 2020 Accepting new patients
Medex Associates, LLC Internal Medicine PastSince May 4, 2009 Accepting new patients
Select Specialty Hospital - Augusta Inc Past Accepting new patients

Locations

3660 J Dewey Gray Cir
Augusta, GA 30909
Phone (706) 210-8884

3651 Wheeler Rd
Augusta, GA 30909
Phone (706) 651-3232

1537 Walton Way
Augusta, GA 30904
Phone (706) 721-1200

501 Redmond Rd NW
Rome, GA 30165
Phone (706) 291-0291

350 Austin Graybill Rd
North Augusta, SC 29860
Phone (706) 736-5244

501 Robertson Blvd
Walterboro, SC 29488
Phone (843) 549-2000

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 9

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379030400000",
    "number": "1821184540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 13TH STREET",
            "address_2": "SUITE 10",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "30901",
            "telephone_number": "706-434-1590",
            "fax_number": "803-279-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 13TH STREET",
            "address_2": "SUITE 10",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "30901",
            "telephone_number": "706-434-1590",
            "fax_number": "803-279-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAKORE",
        "first_name": "HETAL",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2013-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "053556",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "053556",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "053556",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G53556",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "442892357D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF GA",
            "identifier": "52058546-003",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.