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RAFIQ M. EL HAMMALI MD
NPI 1396965547
Internal Medicine - Nephrology in Douglasville, GA

Active since April 30, 2007PECOS EnrolledAccepts Medicare Assignment
92.93/100
CMS Quality Rating
6095 PROFESSIONAL PKWY, SUITE B205, DOUGLASVILLE, GA 30134(770) 577-4825(770) 577-4827 Get Directions Write a Review

NPPES record last updated: December 28, 2015. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Rafiq M. El Hammali Md NPPES

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

RAFIQ M. EL HAMMALI MD (NPI 1396965547) is an individual nephrology provider in Douglasville, Georgia, licensed in Georgia (057606) and active in the NPI registry since April 2007. He is enrolled in Medicare PECOS, is affiliated with Wellstar Kennestone Regional Medical Center, and is a graduate of Other (1998).

NPPES Registry Identity

NPI1396965547
Entity TypeIndividualMale
Primary Taxonomy207RN0300X
Provider Legal NameRAFIQ M. EL HAMMALICredential: MD
Location Address6095 PROFESSIONAL PKWY, SUITE B205Douglasville, GA 30134-5607
Mailing AddressPo Box 385Douglasville, GA 30133-0385 · (770) 577-4825 · Fax (770) 577-4827
Phone(770) 577-4825
Fax(770) 577-4827
Sole ProprietorNo
Medical School CMSOtherGraduated 1998
Enumeration DateApril 30, 2007
Last NPPES UpdateDecember 28, 2015
✔ NPI 1396965547 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians
Taxonomy Code207RN0300X
License✔ Licensed in GA · 057606
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.
Also ListedHospitalistTaxonomy 208M00000X · License 057606 (GA)
6095 PROFESSIONAL PKWY, Douglasville, GA 30134
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Rafiq M. El Hammali Md 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 ID3870684863
PECOS Enrollment IDI20070806000352
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Rafiq El Hammali reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Kidney Care Specialists LLC
Same address
Specialist
6095 PROFESSIONAL PKWY STE B205
Douglasville, GA 30134
  • Reassigned Medicare billing, Georgia enrollment
NPI 1821468711 (770) 577-4825
Southern Nephrology Clinic LLC
0.2 mi
Nephrology
8954 HOSPITAL DR, BUILDING C. SUITE 115
Douglasville, GA 30134
  • Reassigned Medicare billing, Georgia enrollment
NPI 1912198581 (770) 577-4825

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 11

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.

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.
445 services121 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
242 services167 patients
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.
227 services122 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
224 services80 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.
176 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.
88 services16 patients

Hospital Affiliations CMS Care Compare 3

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

Wellstar Kennestone Regional Medical Center

Acute Care Hospitals · Marietta, GA
4/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number110035
Location677 Church StreetMarietta, GA 30060 · Cobb County
Emergency services Birthing friendly

Wellstar Cobb Medical Center

Acute Care Hospitals · Austell, GA
2/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number110143
Location3950 Austell RdAustell, GA 30106 · Cobb County
Birthing friendly

Wellstar Douglas Medical Center

Acute Care Hospitals · Douglasville, GA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number110184
Location8954 Hospital DriveDouglasville, GA 30134 · Douglas County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30134 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
$130.64 typical visit price
range $56.84 – $172.43
Typical copayment $32.66 (range $14.21 – $43.10)
Most-billed visit code 99204
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
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.

92.93/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality80.38
Promoting Interoperability100
Improvement Activities40

Reported Quality Measures

Clinical Information Reconciliation
For at least one transition of care or referral received or patient encounter in which the MIPS eligible clinician has never before encountered the patient, the MIPS eligible clinician performs clinical information reconciliation.
98%1,738 patients4/55-star benchmark: 100%
Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
63%4,000 patients1/55-star benchmark: 100%
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.
93%2,021 patients4/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from certified EHR technology to identify patient-specific educational resources and provide electronic access to those materials to at least one unique patient seen by the MIPS eligible…
73%747 patients3/55-star benchmark: 100%
Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
75%168 patients4/55-star benchmark: 100%
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…
98%586 patients5/55-star benchmark: 97%
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
89%179 patients4/55-star benchmark: 100%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients screenedForUse: 96% · 441 patients
Patients tobacco: 92% · 440 patients
36%28 patients2/55-star benchmark: 98%
Provide Patient Access
For at least one unique patient seen by the MIPS eligible clinician: (1) The patient (or the patient authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The MIPS eligible clinician…
70%747 patients3/55-star benchmark: 100%
Request/Accept Summary of Care
For at least one transition of care or referral received or patient encounter in which the MIPS eligible clinician has never before encountered the patient, the MIPS eligible clinician receives or retrieves and incorporates into the patient's record an…
0%1,737 patients1/55-star benchmark: 100%
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% · 377 patients
0%377 patients5/55-star benchmark: 100%
View, Download and Transmit (VDT)
During the performance period, at least one unique patient (or patient-authorized representatives) seen by the MIPS eligible clinician actively engages with the EHR made accessible by the MIPS eligible clinician.
0%747 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 17

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

DR. BRIDGET DAUPHIN MD
Pediatrics
6095 PROFESSIONAL PKWY, SUITE 100
DOUGLASVILLE, GA 30134
Douglas County (770) 920-2255
WELLSTAR MEDICAL GROUP, LLC
Obstetrics & Gynecology
6095 PROFESSIONAL PKWY, SUITE A-210
DOUGLASVILLE, GA 30134
Douglas County (770) 949-4188
DR. SUZANNE LEE FOX MD
Pediatrics
6095 PROFESSIONAL PKWY, SUITE 100
DOUGLASVILLE, GA 30134
Douglas County (770) 920-2255
DR. ETESHAMUL HUQUE MD
Pediatrics
6095 PROFESSIONAL PKWY, SUITE 100
DOUGLASVILLE, GA 30134
Douglas County (770) 920-2255
NORTHWEST DIAGNOSTIC IMAGING, INC
Radiology (Diagnostic Radiology)
6095 PROFESSIONAL PKWY, SUITE 101B
DOUGLASVILLE, GA 30134
Douglas County (770) 947-8100
MS. PAMELA LANDERS PA
Physician Assistant (Medical)
6095 PROFESSIONAL PKWY, SUITE 100
DOUGLASVILLE, GA 30134
Douglas County (770) 920-2255
WELLSTAR NORTH DOUGLAS OB/GYN, LLC
Obstetrics & Gynecology
6095 PROFESSIONAL PKWY, SUITE A 210
DOUGLASVILLE, GA 30134
Douglas County (770) 949-4188
WELLSTAR CREEKSIDE PEDIATRICS, LLC
Pediatrics
6095 PROFESSIONAL PKWY, SUITE 100
DOUGLASVILLE, GA 30134
Douglas County (770) 920-2255

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 Rafiq El Hammali's NPI number?

The NPI number for Rafiq El Hammali is 1396965547. It was assigned to this individual provider in the NPPES registry on April 30, 2007.

Where is Rafiq El Hammali located?

Rafiq El Hammali practices at 6095 Professional Pkwy Suite B205, Douglasville, GA 30134. The listed phone number is (770) 577-4825.

What is Rafiq El Hammali's specialty?

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

Is Rafiq El Hammali enrolled in Medicare?

Yes. Rafiq El Hammali 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.

Which organizations bill Medicare for Rafiq El Hammali's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Rafiq El Hammali reassigns Medicare benefits to 2 organizations: Kidney Care Specialists LLC (Douglasville, GA) and Southern Nephrology Clinic LLC (Douglasville, GA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Rafiq El Hammali's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Rafiq El Hammali accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama and Ambetter of North Carolina and 2 other insurers list Rafiq El Hammali 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 Rafiq El Hammali affiliated with any hospitals?

According to CMS data, Rafiq El Hammali is affiliated with Wellstar Kennestone Regional Medical Center, Wellstar Cobb Medical Center and Wellstar Douglas Medical Center.

When was this NPI record last updated?

The NPPES record for Rafiq El Hammali was last updated on December 28, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.