Individual provider Active NPI

Robert O'Connell, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Carrollton, GA
National Provider Identifier
1063832020
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
97890 Issued in GA
Practice address
150 Clinic Ave Ste 101
Carrollton, GA 30117-4402
Phone
(770) 834-0873
Fax
(770) 834-6118
NPI assigned
Apr 17, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 97890 GA Primary

Addresses

Primary practice location

150 Clinic Ave Ste 101
Carrollton, GA 30117-4402

Mailing address

150 Clinic Ave Ste 101
Carrollton, GA 30117-4402
Phone (770) 834-0873

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
I20231220000403 GA Practitioner - Orthopedic Surgery 0244558369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Virginia Commonwealth University, School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carrollton Orthopaedic Clinic PCGroup PAC ID 7810989183, 31 clinicians

Practice addresses (Care Compare)

150 Clinic Ave
Carrollton, GA 30117-4498
Phone (770) 834-0873

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.95 of 100Reported as group
Quality
69.91
Promoting interoperability
99
Improvement activities
40
Cost
77.42

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)42
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
97890GAMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carrollton Orthopaedic Clinic PC Orthopaedic Surgery CurrentSince Dec 5, 2023 Accepting new patients

Locations

150 Clinic Ave
Ste 101
Carrollton, GA 30117
Phone (770) 834-0873

150 Clinic Ave
Carrollton, GA 30117
Phone (770) 834-0873

401 Permian Way
Ste D
Villa Rica, GA 30180

705 Dallas Hwy
Ste 301
Villa Rica, GA 30180
Phone (770) 456-0211

Organizations & group practices 1

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": "1397692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1063832020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 CLINIC AVE STE 101",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174402",
            "telephone_number": "770-834-0873",
            "fax_number": "770-834-6118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 CLINIC AVE STE 101",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174402",
            "telephone_number": "770-834-0873",
            "fax_number": "770-834-6118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNELL",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-17",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "GA",
            "license": "97890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.