DR. ASHISH DHUNGEL M.D
NPI 1043421175
Internal Medicine - Nephrology in Newnan, GA

Active since May 24, 2007PECOS EnrolledAccepts Medicare Assignment
89.89/100
CMS Quality Rating
1425 HIGHWAY 34 E, NEWNAN, GA 30265(770) 304-3724 Get Directions Write a Review

NPPES record last updated: October 31, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Oct 31, 2022, Mar 18, 2019, Oct 16, 2018 and 1 more (4 updates tracked since 2016).

About Dr. Ashish Dhungel M.d NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ASHISH DHUNGEL M.D (NPI 1043421175) is an individual nephrology provider in Newnan, Georgia, licensed in Georgia (64359) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS, is affiliated with Piedmont Fayette Hospital, and maintains a secondary practice location in Peachtree City.

NPPES Registry Identity

NPI1043421175
Entity TypeIndividualMale
Primary Taxonomy207RN0300X
Provider Legal NameDR. ASHISH DHUNGELCredential: M.D
Location Address1425 HIGHWAY 34 ENewnan, GA 30265-1323
Mailing Address1425 Highway 34 ENewnan, GA 30265-1323 · (770) 304-3724
Sole ProprietorYes
Medical School CMSOtherGraduated 2000
Enumeration DateMay 24, 2007
Last NPPES UpdateOctober 31, 20224 updates tracked since enumeration
NPPES CertifiedOctober 31, 2022
NPI 1043421175 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians
Taxonomy Code207RN0300X
License Licensed in GA · 64359
Definition
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.
1425 HIGHWAY 34 E, Newnan, GA 30265

Secondary Practice Location 1

Location 1130 Governors Sq Ste CPeachtree City, GA 30269-4862 · Phone (770) 376-6256

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Ashish Dhungel M.d is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8628251089
PECOS Enrollment IDI20110322000565
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 12

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
912 services437 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
569 services175 patients
Dialysis services, 4 or more physician visits per month (20 years or older) 90960
Dialysis is a treatment that filters and purifies your blood using a machine. It helps keep your fluids and electrolytes in balance when the kidneys can't do their job. This service includes 4 or more visits per month with a physician to monitor your health and adjust your treatment as needed.
124 services50 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
102 services86 patients
Dialysis services, 2-3 physician visits per month (20 years or older) 90961
Dialysis is a treatment that performs the function of healthy kidneys if they're not working properly. It removes waste and excess fluid from your blood. 2-3 physician visits per month are recommended for monitoring your health and adjusting your treatment as needed. This service is available for those aged 20 years and older.
63 services34 patients
Home dialysis services per month (20 years or older) 90966
Home dialysis services provide kidney treatment for patients aged 20 or older right in their own homes. This service includes necessary equipment, supplies, and support for performing dialysis. It's a convenient option that allows patients to maintain their daily routines while receiving essential care.
57 services19 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Piedmont Fayette Hospital

Acute Care Hospitals · Fayetteville, GA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number110215
Location1255 Highway 54 WestFayetteville, GA 30214 · Fayette County
Emergency services Birthing friendly

Piedmont Newnan Hospital, Inc

Acute Care Hospitals · Newnan, GA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number110229
Location745 Poplar RoadNewnan, GA 30265 · Coweta County
Emergency services Birthing friendly

Southeastern Regional Medical Center, Inc

Acute Care Hospitals · Newnan, GA
5/5 CMS rating
OwnershipProprietary
CMS Certification Number110233
Location600 Celebrate Life Parkway NorthNewnan, GA 30265 · Coweta County

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30265 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$124.10 typical visit price
range $53.31 – $164.04
Typical copayment $31.02 (range $13.32 – $41.01)
Most-billed visit code 99204
Established Patient
$94.84 typical visit price
range $16.68 – $133.24
Typical copayment $23.71 (range $4.17 – $33.31)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

89.89/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality79.78
Promoting Interoperability100
Improvement Activities40

Reported Quality Measures

Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
65%730 patients4/55-star benchmark: 85%
Diabetes: Eye Exam
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
9%46 patients1/55-star benchmark: 100%
Diabetes: Medical Attention for Nephropathy
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
100%433 patients5/55-star benchmark: 99%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
98%2,577 patients4/55-star benchmark: 99%
Falls: Screening for Future Fall Risk
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
69%849 patients3/55-star benchmark: 99%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
93%987 patients3/55-star benchmark: 100%
Medication Reconciliation Post-Discharge
The percentage of discharges from any inpatient facility (e.g. hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years and older of age seen within 30 days following discharge in the office by the physician, prescribing…
Patients 65+: 96% · 54 patients
97%62 patients
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
76%1,284 patients4/55-star benchmark: 97%
Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
75%859 patients4/55-star benchmark: 90%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
89%518 patients4/55-star benchmark: 100%
Preventive Care and Screening: Influenza Immunization
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization
61%1,015 patients3/55-star benchmark: 88%
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen
1%451 patients1/55-star benchmark: 100%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
98%1,284 patients4/55-star benchmark: 100%
Screening for Osteoporosis for Women Aged 65-85 Years of Age
Percentage of female patients aged 65-85 years of age who ever had a central dual-energy X-ray absorptiometry (DXA) to check for osteoporosis
52%166 patients3/55-star benchmark: 98%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
37%1,284 patients2/55-star benchmark: 89%
Use of High-Risk Medications in the Elderly
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication.
Lower rates are better for this measure.
Patients 2+: 0% · 859 patients
1%859 patients4/55-star benchmark: 100%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
38%1,284 patients
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine (Nephrology)
1425 HIGHWAY 34 E
NEWNAN, GA 30265
Internal Medicine (Nephrology)
1425 HIGHWAY 34 E
NEWNAN, GA 30265
Dietitian, Registered
1425 HIGHWAY 34 E
NEWNAN, GA 30265
Internal Medicine (Nephrology)
1425 HIGHWAY 34 E
NEWNAN, GA 30265
Dietitian, Registered
1425 HIGHWAY 34 E
NEWNAN, GA 30265
Nurse Practitioner
1425 HIGHWAY 34 E
NEWNAN, GA 30265
Nurse Practitioner (Family)
1425 HIGHWAY 34 E
NEWNAN, GA 30265
Internal Medicine (Nephrology)
1425 HIGHWAY 34 E
NEWNAN, GA 30265

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ashish Dhungel's NPI number?

The NPI number for Ashish Dhungel is 1043421175. It was assigned to this individual provider in the NPPES registry on May 24, 2007.

Where is Ashish Dhungel located?

Ashish Dhungel practices at 1425 Highway 34 E, Newnan, GA 30265. The listed phone number is (770) 304-3724.

What is Ashish Dhungel's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Is Ashish Dhungel enrolled in Medicare?

Yes. Ashish Dhungel is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Ashish Dhungel accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Ashish Dhungel as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Ashish Dhungel affiliated with any hospitals?

According to CMS data, Ashish Dhungel is affiliated with Piedmont Fayette Hospital, Piedmont Newnan Hospital, Inc and Southeastern Regional Medical Center, Inc.

When was this NPI record last updated?

The NPPES record for Ashish Dhungel was last updated on October 31, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.