NPIMap

Organization Active NPI

Reagan Medical Center LLC

  • Family Medicine Physician
  • Suwanee, GA
National Provider Identifier
1952316747
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
REAGAN MEDICAL CENTER LLC
Practice address
2696 Lawrenceville Suwanee Rd
Suwanee, GA 30024-2535
Phone
(678) 344-8700
NPI assigned
Jul 30, 2006
Last updated
Apr 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Authorized official

Name
Mr. Satish Poddar, MDNPI 1083603922
Title
Ceo
Phone
(678) 344-8700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Neurological Surgery Physician 207T00000X
Physical Therapist 225100000X

Addresses

Primary practice location

2696 Lawrenceville Suwanee Rd
Suwanee, GA 30024-2535

Mailing address

2878 Five Forks Trickum Rd
Ste 2a
Lawrenceville, GA 30044-5896
Phone (678) 344-8700

Other practice location 1

289 Grayson Hwy
Lawrenceville, GA 30046-5726
Phone (770) 771-5560

Other practice location 2

10160 Medlock Bridge Rd Ste B
Johns Creek, GA 30097-4419
Phone (678) 584-1622

Other practice location 3

3685 Braselton Hwy Ste 105
Dacula, GA 30019-5920
Phone (678) 344-8700

Other practice location 4

2878 Five Forks Trickum Rd
ste 2a
Lawrenceville, GA 30044-5896
Phone (678) 344-8700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000573 GA Part B Supplier - Clinic/Group Practice 6507779329 Receives reassigned benefits from 55 practitioners
6 other NPIs on this enrollment
Practice locations: Lawrenceville, GA; Suwanee, GA; Johns Creek, GA; Dacula, GA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0959517Reagan Medical Center2878 Five Forks Trickum Rd Ste 2-a, Lawrenceville, GA 30044ComplianceSep 19, 2026
11D2177464Reagan Medical Center289 Grayson Highway, Lawrenceville, GA 30046Certificate of waiverJan 12, 2028

National Provider Directory

National Provider Directory

Locations

11780 Northfall Ln
Alpharetta, GA 30009
Phone (888) 510-1352

426 Exchange Blvd
Ste 500
Bethlehem, GA 30620
Phone (470) 437-2562

3685 Braselton Hwy
Ste 105
Dacula, GA 30019

10160 Medlock Bridge Rd
Johns Creek, GA 30097
Phone (770) 495-0011

10160 Medlock Bridge Rd
#B
Johns Creek, GA 30097

2878 Five Forks Trickum Rd
Lawrenceville, GA 30044
Phone (770) 344-8700

2878 Five Forks Trickum Rd
Ste 1A
Lawrenceville, GA 30044
Phone (770) 978-4419

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1952316747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2878 FIVE FORKS TRICKUM RD",
            "address_2": "STE 2A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300445896",
            "telephone_number": "678-344-8700",
            "fax_number": "678-344-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2696 LAWRENCEVILLE SUWANEE RD",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242535",
            "telephone_number": "678-344-8700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "289 Grayson Hwy",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300465726",
            "country_code": "US",
            "telephone_number": "770-771-5560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10160 Medlock Bridge Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Johns Creek",
            "state": "GA",
            "postal_code": "300974419",
            "country_code": "US",
            "telephone_number": "678-584-1622",
            "fax_number": "678-584-1673",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3685 Braselton Hwy Ste 105",
            "address_purpose": "LOCATION",
            "city": "Dacula",
            "state": "GA",
            "postal_code": "300195920",
            "country_code": "US",
            "telephone_number": "678-344-8700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2878 Five Forks Trickum Rd",
            "address_2": "ste 2a",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300445896",
            "country_code": "US",
            "telephone_number": "678-344-8700",
            "fax_number": "678-344-8600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REAGAN MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "PODDAR",
        "authorized_official_first_name": "SATISH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-344-8700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suwanee, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.