Nibedita Patro, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

058092 Issued in GA

Practice address

1080 Sanders Rd
Ste 100
Cumming, GA 30041-8057

Phone

(770) 887-2323

Fax

(770) 887-2325

NPI assigned

Sep 25, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

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, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Urgent Care Holding LLCGroup PAC ID 4587984695, 77 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Northside Urgent Care Holding, LLC

  • Urgent Care Clinic/Center
  • Atlanta, GA
  • NPI 1679962237
  Medicare reassignment Care Compare group NPD
• Northside Primary Care Professional Services,LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1922397553
  Medicare reassignment NPD
• Northside Primary Care Professional Services, LLC

  • Urgent Care Clinic/Center
  • Dawsonville, GA
  • NPI 1215369715
  NPD
• Gwinnett Clinic LTD

  • Multi-Specialty Clinic/Center
  • Duluth, GA
  • NPI 1629117650
  NPD (past)

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1992805006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 SANDERS RD",
            "address_2": "STE 100",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300418057",
            "telephone_number": "770-887-2323",
            "fax_number": "770-887-2325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 SANDERS RD",
            "address_2": "STE 100",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300418057",
            "telephone_number": "770-887-2323",
            "fax_number": "770-887-2325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRO",
        "first_name": "NIBEDITA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "058092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085000920G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000974509M",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000974509N",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000974509L",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nibedita.patro@lfpi.eclinicaldirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "1080 Sanders Rd",
            "address_2": "Ste 100",
            "city": "Cumming",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300418057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ujwal Patel, MD
• Urviben Rekshitkumar Patel, MD, MPH
• Path to Change, LLC
• Pathways to Change, LLC
• Rani Patil, MD
• Ella Grace Patten
• Keith Douglas Patterson, PHARM.D.
• Madilyn Patterson
• Michael Patterson, MD
• Monica Patterson, AUD

• Family Medicine Physician in Cumming, GA
• Providers in Cumming, 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 Feb 26, 2021; 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.