Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MISS KHEMAPORN LERTDETKAJORN MD
NPI 1871089367
Internal Medicine - Endocrinology, Diabetes & Metabolism in Riverdale, GA

Q: What is Khemaporn Lertdetkajorn's NPI number?

The NPI number for Khemaporn Lertdetkajorn is 1871089367. It was assigned to this individual provider in the NPPES registry on July 8, 2018.

Q: What is Khemaporn Lertdetkajorn's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Endocrinology, Diabetes & Metabolism, with taxonomy code 207RE0101X.

Active since July 08, 2018PECOS EnrolledAccepts Medicare Assignment

33 UPPER RIVERDALE RD SW STE 111, RIVERDALE, GA 30274(770) 909-2045(770) 909-2056 Get Directions Write a Review

NPPES record last updated: June 30, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Miss Khemaporn Lertdetkajorn Md NPPES

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

MISS KHEMAPORN LERTDETKAJORN MD (NPI 1871089367) is an individual endocrinology, diabetes & metabolism provider in Riverdale, Georgia, licensed in Georgia (100193) and active in the NPI registry since July 2018. She is enrolled in Medicare PECOS, is affiliated with Southern Regional Medical Center, and is a graduate of Other (2015).

NPPES Registry Identity

NPI1871089367

Entity TypeIndividualFemale

Primary Taxonomy207RE0101X

Provider Legal NameMISS KHEMAPORN LERTDETKAJORNCredential: MD

Location Address33 UPPER RIVERDALE RD SW STE 111Riverdale, GA 30274-2642

Mailing Address33 Upper Riverdale Rd Sw Ste 111Riverdale, GA 30274-2642 · (770) 909-2045 · Fax (770) 909-2056

Phone(770) 909-2045

Fax(770) 909-2056

Sole ProprietorYes

Medical School CMSOtherGraduated 2015

Enumeration DateJuly 8, 2018

Last NPPES UpdateJune 30, 2026

NPPES CertifiedJune 30, 2026

✔ NPI 1871089367 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Endocrinology, Diabetes & MetabolismAllopathic & Osteopathic Physicians

Taxonomy Code207RE0101X

License✔ Licensed in GA · 100193

Definition

An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.

33 UPPER RIVERDALE RD SW STE 111, Riverdale, GA 30274

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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

Miss Khemaporn Lertdetkajorn 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 ID8820407059

PECOS Enrollment IDI20250204002822

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.

Hospital Affiliations CMS Care Compare

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

Southern Regional Medical Center

Acute Care Hospitals · Riverdale, GA

1/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number110165

Location11 Upper Riverdale Road, SWRiverdale, GA 30274 · Clayton County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30274 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.

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 Khemaporn Lertdetkajorn's NPI number?

The NPI number for Khemaporn Lertdetkajorn is 1871089367. It was assigned to this individual provider in the NPPES registry on July 8, 2018.

Where is Khemaporn Lertdetkajorn located?

Khemaporn Lertdetkajorn practices at 33 Upper Riverdale Rd SW Ste 111, Riverdale, GA 30274. The listed phone number is (770) 909-2045.

What is Khemaporn Lertdetkajorn's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Endocrinology, Diabetes & Metabolism, with taxonomy code 207RE0101X.

Is Khemaporn Lertdetkajorn enrolled in Medicare?

Yes. Khemaporn Lertdetkajorn 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 Khemaporn Lertdetkajorn affiliated with any hospitals?

According to CMS data, Khemaporn Lertdetkajorn is affiliated with Southern Regional Medical Center.

When was this NPI record last updated?

The NPPES record for Khemaporn Lertdetkajorn was last updated on June 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 42 days 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.