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LOCUST GROVE FAMILY MEDICINE
NPI 1629169164
Non-Pharmacy Dispensing Site in Locust Grove, GA

Active since September 28, 2006CLIA 11D1017382 · Microscopy
3778 HIGHWAY 42, LOCUST GROVE, GA 30248(678) 610-6649(678) 610-6025 Get Directions Write a Review

NPPES record last updated: March 14, 2016. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Mar 14, 2016, Jan 21, 2016 (2 updates tracked since 2016).

About Locust Grove Family Medicine NPPES

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

LOCUST GROVE FAMILY MEDICINE (NPI 1629169164) is a healthcare organization registered as a non-pharmacy dispensing site in Locust Grove, Georgia and active in the NPI registry since September 2006. The organization holds a CLIA Microscopy certificate valid through September 23, 2027 and lists Nimisha J Trivedi, Owner, as its authorized official.

NPPES Registry Identity

NPI1629169164
Entity TypeOrganization
Primary Taxonomy332900000X
Legal Business NameLOCUST GROVE FAMILY MEDICINE
Location Address3778 HIGHWAY 42Locust Grove, GA 30248-3632
Mailing Address3778 Highway 42Locust Grove, GA 30248-3632 · (678) 610-6649 · Fax (678) 610-6025
Phone(678) 610-6649
Fax(678) 610-6025
Organization SubpartNo
Authorized OfficialNimisha J TrivediOwner · (678) 610-6649
Enumeration DateSeptember 28, 2006
Last NPPES UpdateMarch 14, 20162 updates tracked since enumeration
✔ NPI 1629169164 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers
Taxonomy Code332900000X
License✔ Licensed in GA · 053715
Definition
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)
Also ListedFamily MedicineTaxonomy 207Q00000X · License 053715 (GA)
3778 HIGHWAY 42, Locust Grove, GA 30248
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Locust Grove Family Medicine is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

7

Medicare enrollment records show 7 clinicians reassign Medicare billing to Locust Grove Family Medicine, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 5 within 10 miles. They are listed nearest first.

Clinicians, nearest first (7)

Chetan Sharma, M.D.
Family Practice
NPI 1871763011
3778 HIGHWAY 42
Locust Grove, GA 30248
(678) 610-6649
✔ PECOSSame address
Nimisha Trivedi, MD
Family Practice
NPI 1629074299
3778 HIGHWAY 42
Locust Grove, GA 30248
(678) 610-6649
✔ PECOSSame address
Remonne Joseph, FNP
Nurse Practitioner
NPI 1801252176
536 ROSALIND TER
Locust Grove, GA 30248
(917) 860-0634
✔ PECOS✔ Accepts Medicare0.9 mi
Tina Jordan, FNP
Nurse Practitioner
NPI 1255703088
4631 BILL GARDNER PKWY
Locust Grove, GA 30248
(770) 630-6281
✔ PECOS✔ Accepts Medicare1.0 mi
Althea Dimaculangan, NP-C
Nurse Practitioner
NPI 1609255066
345 HUNTINGTON PLACE CT
Mcdonough, GA 30253
(678) 272-7280
✔ PECOS✔ Accepts Medicare8.1 mi
Tamika Martin
Nurse Practitioner
NPI 1598206294
1404 SOUTHLAKE PLAZA DR
Morrow, GA 30260
(404) 436-1876
✔ PECOS✔ Accepts Medicare21 mi
Kristie Watts, FNP
Nurse Practitioner
NPI 1932808631
164 BRADLEY CIR
Barnesville, GA 30204
(678) 572-8563
✔ PECOS✔ Accepts Medicare21 mi

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 11D1017382

Locust Grove Family Medicine PC · Locust Grove, GA
Active · expires Sep 23, 2027
CLIA Number11D1017382
Laboratory TypePhysician Office
Certificate Effective DateSeptember 24, 2025
Certificate Expiration DateSeptember 23, 2027
Laboratory DirectorNimisha J. Trivedi
Laboratory Phone(770) 898-6054
Laboratory LocationLocust Grove Family Medicine PC3778 Highway 42, Locust Grove, GA 30248
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

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 Locust Grove Family Medicine's NPI number?

The NPI number for Locust Grove Family Medicine is 1629169164. It was assigned to this organization in the NPPES registry on September 28, 2006.

Where is Locust Grove Family Medicine located?

Locust Grove Family Medicine is located at 3778 Highway 42, Locust Grove, GA 30248. The listed phone number is (678) 610-6649.

What is Locust Grove Family Medicine's specialty?

The primary specialty registered for this NPI is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

Is Locust Grove Family Medicine enrolled in Medicare?

Yes. Locust Grove Family Medicine is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Locust Grove Family Medicine?

According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians in 2 Medicare specialties reassign their Medicare billing to Locust Grove Family Medicine. A 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 the clinician's services. The largest specialties are Nurse Practitioner (5) and Family Practice (2). Of these, 2 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Locust Grove Family Medicine hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 11D1017382) is associated with this NPI, valid through September 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Locust Grove Family Medicine accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee and 6 other insurers list Locust Grove Family Medicine 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.

When was this NPI record last updated?

The NPPES record for Locust Grove Family Medicine was last updated on March 14, 2016. 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.