Individual provider Active NPI

Vanchad C Memark, M.D.

  • Surgery Physician
  • Hiram, GA
National Provider Identifier
1013196492
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
64416 Issued in GA
Practice address
148 Bill Carruth Pkwy
Suite 180
Hiram, GA 30141-3754
Phone
(770) 445-4915
Fax
(770) 445-2876
NPI assigned
Nov 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 64416 GA Primary

Addresses

Primary practice location

148 Bill Carruth Pkwy
Suite 180
Hiram, GA 30141-3754

Mailing address

148 Bill Carruth Pkwy
Suite 180
Hiram, GA 30141-3754
Phone (770) 445-4915

Other identifiers 1

IdentifierTypeStateIssuer
2949877MedicaidOH

Other names 1

  • Ron C Memark Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100721000600 GA Practitioner - General Surgery 3375696503 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Loyola University of Chicago, Stritch School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

148 Bill Carruth Pkwy
Hiram, GA 30141-3756

2518 Jimmy Lee Smith Pkwy
Hiram, GA 30141-2068
Phone (770) 732-4022

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

Hospital & facility affiliations

  • Wellstar Paulding Medical Center Hospital, Hiram, GA, CCN 110042
  • Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143
  • Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)14
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
64416GAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Cardiovascular Medicine, LLC Past Accepting new patients
Wellstar Medical Group, LLC Surgery Past Accepting new patients

Locations

4904 Timber Ridge Dr
Ste 104
Douglasville, GA 30135
Phone (770) 942-4822

6002 Professional Pkwy
Ste 260
Douglasville, GA 30134
Phone (470) 644-5411

148 Bill Carruth Pkwy
Ste 180
Hiram, GA 30141
Phone (770) 445-1915

5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

Networks

  • devoted network organization-14bfd35d-d818-4696-813b-340339e464ef
  • AL HMO
  • devoted network organization-d5084670-562f-408b-b100-22a1a4ef4d82
  • devoted network organization-25ba88d3-d0a6-4213-84f1-eef6f2b59f68
  • AL HMO D-SNP

Interoperability endpoints

  • Direct secure messaging: vmemark24549@directwellstar.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485734400000",
    "number": "1013196492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 BILL CARRUTH PKWY",
            "address_2": "SUITE 180",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301413754",
            "telephone_number": "770-445-4915",
            "fax_number": "770-445-2876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 BILL CARRUTH PKWY",
            "address_2": "SUITE 180",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301413754",
            "telephone_number": "770-445-4915",
            "fax_number": "770-445-2876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEMARK",
        "first_name": "VANCHAD",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-01",
        "last_updated": "2017-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "64416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2949877",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RON",
            "last_name": "MEMARK",
            "middle_name": "C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hiram, GA

Sources for this page

Verify at the official NPI Registry.