NPIMap

Individual provider Active NPI

Matthew Charles Agan, M.D.

  • Neurology Physician
  • Marietta, GA
National Provider Identifier
1013250679
Registry record updated Aug 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
078898 Issued in GA
Practice address
780 Canton Rd NE Ste 400
Marietta, GA 30060-7298
Phone
(770) 488-3602
NPI assigned
Apr 2, 2013
Last updated
Aug 15, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 078898 GA Primary

Addresses

Primary practice location

780 Canton Rd NE Ste 400
Marietta, GA 30060-7298

Mailing address

780 Canton Rd NE Ste 400
Marietta, GA 30060-7298
Phone (770) 488-3602

Other practice location 1

1364 Clifton Rd NE
Atlanta, GA 30322-1059
Phone (404) 778-0263

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181107000802 GA Practitioner - Neurology 9436403672 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Emory University School of Medicine, 2013
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)

780 Canton Rd NE
Suite 400
Marietta, GA 30060-7298
Phone (770) 422-3602

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
078898GAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Aug 6, 2018 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Cardiovascular Medicine, LLC Past Accepting new patients

Locations

1364 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 712-7100

8954 Hospital Dr
Douglasville, GA 30134
Phone (678) 838-2584

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

780 Canton Rd NE
Ste 400
Marietta, GA 30060
Phone (770) 422-3602

Networks

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

Interoperability endpoints

  • Direct secure messaging: magan176241@directwellstar.org

Organizations & group practices 3

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

Hospital & facility affiliations 6

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": "1364860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1013250679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 CANTON RD NE STE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607298",
            "telephone_number": "770-488-3602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 CANTON RD NE STE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607298",
            "telephone_number": "770-488-3602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1364 Clifton Rd NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303221059",
            "country_code": "US",
            "telephone_number": "404-778-0263",
            "fax_number": "404-778-1601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGAN",
        "first_name": "MATTHEW",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-02",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "078898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.