SAMMY M. MUGAMBI M.D.
NPI 1427077510
Internal Medicine - Nephrology in Atlanta, GA
Active since July 19, 2006PECOS EnrolledAccepts Medicare Assignment
About Sammy M. Mugambi M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMMY M. MUGAMBI M.D. (NPI 1427077510) is an individual nephrology provider in Atlanta, Georgia, licensed in Georgia (056739) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS, is affiliated with Emory Decatur Hospital, and is a graduate of Other (1998).
NPPES Registry Identity
NPI1427077510
Entity TypeIndividualMale
Primary Taxonomy207RN0300X
Provider Legal NameSAMMY M. MUGAMBICredential: M.D.
Location Address3620 M L KING JR DR SWAtlanta, GA 30331-3711
Mailing Address3620 M L King Jr Dr SwAtlanta, GA 30331-3711 · (404) 696-7300 · Fax (404) 699-3514
Phone(404) 696-7300
Fax(404) 699-3514
Sole ProprietorNo
Medical School CMSOtherGraduated 1998
Enumeration DateJuly 19, 2006
Last NPPES UpdateDecember 17, 2020
NPPES CertifiedDecember 17, 2020
✔ NPI 1427077510 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 · 056739
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.
3620 M L KING JR DR SW, Atlanta, GA 30331
Other Identifiers 10
Medicaid860055859HGA
Other7605112GA · Cigna
Other7974749GA · Aetna
Medicaid860055859JGA
Other2583820GA · United Health Care
Medicaid860055859GGA
Medicaid860055859IGA
Medicaid860055859MGA
Medicaid860055859LGA
Medicaid860055859KGA
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
Sammy M. Mugambi 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 ID5991738486
PECOS Enrollment IDI20050915000123
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.
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.
388 services92 patients
Management using the results of remote vital sign monitoring per calendar month, first 20 minutes 99457
This service involves reviewing and managing your health data, which is remotely monitored and collected. Your vital signs like heart rate and blood pressure are tracked regularly throughout the month. The first 20 minutes of this data analysis per month is included in this service.
178 services20 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.
141 services24 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.
140 services27 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.
96 services33 patients
Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days 99454
This service involves using devices to remotely track body functions like heart rate or blood pressure. These devices, provided initially, record data daily or send alerts if readings are abnormal. The service is renewed every 30 days.
86 services15 patients
Hospital Affiliations CMS Care Compare 3
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Emory Decatur Hospital
Acute Care Hospitals · Decatur, GAOwnershipVoluntary non-profit - Private
CMS Certification Number110076
Location2701 N Decatur RoadDecatur, GA 30033 · De Kalb County
Emergency services Birthing friendly
Emory University Hospital Midtown
Acute Care Hospitals · Atlanta, GAOwnershipVoluntary non-profit - Private
CMS Certification Number110078
Location550 Peachtree Street, NEAtlanta, GA 30308 · Fulton County
Emergency services Birthing friendly
Piedmont Hospital
Acute Care Hospitals · Atlanta, GAOwnershipVoluntary non-profit - Private
CMS Certification Number110083
Location1968 Peachtree Rd NWAtlanta, GA 30309 · Fulton County
Emergency services Birthing friendly
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30331 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.
Reported Quality Measures
Care Plan
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker…
89%178 patients4/55-star benchmark: 100%
Diabetes: Foot Exam
The percentage of patients 18-75 years of age with diabetes (type 1 and type 2) who received a foot exam (visual inspection and sensory exam with mono filament and a pulse exam) during the measurement year
98%62 patients5/55-star benchmark: 98%
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.
100%637 patients5/55-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.
94%1,727 patients4/55-star benchmark: 99%
Health Information Exchange
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for…
77%285 patients4/55-star benchmark: 88%
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.
99%107 patients4/55-star benchmark: 100%
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.
100%249 patients5/55-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
44%125 patients2/55-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…
100%214 patients5/55-star benchmark: 97%
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
23%241 patients2/55-star benchmark: 88%
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: 100% · 167 patients
99%157 patients5/55-star benchmark: 98%
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…
89%249 patients4/55-star benchmark: 100%
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…
100%249 patients5/55-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+: 1% · 125 patients
1%130 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.
43%249 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 4
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Internal Medicine (Nephrology)
3620 M L KING JR DR SW
ATLANTA, GA 30331
ATLANTA, GA 30331
Internal Medicine (Nephrology)
3620 M L KING JR DR SW
ATLANTA, GA 30331
ATLANTA, GA 30331
Internal Medicine (Nephrology)
3620 M L KING JR DR SW
ATLANTA, GA 30331
ATLANTA, GA 30331
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 Sammy Mugambi's NPI number?
The NPI number for Sammy Mugambi is 1427077510. It was assigned to this individual provider in the NPPES registry on July 19, 2006.
Where is Sammy Mugambi located?
Sammy Mugambi practices at 3620 M L King Jr Dr SW, Atlanta, GA 30331. The listed phone number is (404) 696-7300.
What is Sammy Mugambi's specialty?
The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.
Is Sammy Mugambi enrolled in Medicare?
Yes. Sammy Mugambi 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.
Is Sammy Mugambi affiliated with any hospitals?
According to CMS data, Sammy Mugambi is affiliated with Emory Decatur Hospital, Emory University Hospital Midtown and Piedmont Hospital.
When was this NPI record last updated?
The NPPES record for Sammy Mugambi was last updated on December 17, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Sammy M. Mugambi, M.D. · NPI 1427077510
Nephrology physician in Atlanta, Georgia. Individual provider, active in the CMS NPPES registry since July 19, 2006.
## Identity
- **NPI:** 1427077510 (Entity type: Individual)
- **Enumerated:** July 19, 2006
- **Primary specialty:** Internal Medicine - Nephrology · taxonomy 207RN0300X
- **State license:** 056739 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 3620 M L KING JR DR SW, Atlanta, GA 30331-3711
- **Phone:** (404) 696-7300 · **Fax:** (404) 699-3514
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 1998
## Record status
- **NPPES last updated:** December 17, 2020
- **Other identifiers:** Medicaid 860055859H (GA); Other 7605112 (GA); Other 7974749 (GA); and 7 more
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Source: [NPI Profile](https://npiprofile.com/npi/1427077510) · Data from the CMS NPPES public registry.