Jayashree Venkatesh, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

065912 Issued in GA

Practice address

1435 Broadmoor Blvd
Kaiser Permanente Sugar Hill-Buford Medical Center
Sugar Hill, GA 30518

Phone

(678) 765-5700

Fax

(540) 636-8920

NPI assigned

Feb 17, 2006

Last updated

Mar 7, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Jayashree Venugopal Purushothamalu Former name

Electronic endpoints 1

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

Specialty

Family Practice

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)
• Shenandoah Valley Family Health Center

  dba Shenandoah Valley Medical System,Inc.

  • Federally Qualified Health Center (FQHC)
  • Inwood, WV
  • NPI 1881893550

  Family Medicine

  NPD (past)
• Shenandoah Valley Medical System, Inc.

  dba Winchester Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Winchester, VA
  • NPI 1023217452
  NPD (past)
• Shenandoah Valley Medical System, Inc.

  dba Shenandoah Community Health Widmyer Elementary

  • Federally Qualified Health Center (FQHC)
  • Berkeley Springs, WV
  • NPI 1568186153
  NPD (past)

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1851366454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT ROAD, NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30305",
            "telephone_number": "404-504-5678",
            "fax_number": "540-636-8920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1435 BROADMOOR BLVD",
            "address_2": "KAISER PERMANENTE SUGAR HILL-BUFORD MEDICAL CENTER",
            "city": "SUGAR HILL",
            "state": "GA",
            "postal_code": "30518",
            "telephone_number": "678-765-5700",
            "fax_number": "540-636-8920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENKATESH",
        "first_name": "JAYASHREE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101237911",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "065912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00670504",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010147735",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1435 Broadmoor Blvd",
            "address_2": "Kaiser Permanente Sugar Hill-Buford Medical Center",
            "city": "Sugar Hill",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JAYASHREE",
            "last_name": "PURUSHOTHAMALU",
            "middle_name": "VENUGOPAL",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Vedic ABA LLC
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• Walgreen Co (Rite Aid #11811)
• Walgreen Co (Walgreens #09494)

• Family Medicine Physician in Sugar Hill, GA
• Providers in Sugar Hill, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.