Individual provider Active NPI

Emily Ryan-Michailidis, D.O.

  • Physical Medicine & Rehabilitation Physician
  • Roswell, GA
National Provider Identifier
1073045274
Registry record updated Oct 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
90254 Issued in GA
Practice address
1109 Green St
Roswell, GA 30075-3609
Phone
(201) 654-6397
Fax
(314) 405-9284
NPI assigned
Mar 28, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 90254 GA Primary

Addresses

Primary practice location

1109 Green St
Roswell, GA 30075-3609

Mailing address

650 Ponce de Leon Ave Ste. 300
#1635
Atlanta, GA 30308

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
I20211025000317 GA Practitioner - Physical Medicine and Rehabilitation 4587904164 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emory Medical Care Foundation IncGroup PAC ID 4981501814, 1,003 clinicians

Practice addresses (Care Compare)

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3031
Phone (404) 616-1000

Hospital & facility affiliations

  • Interim Healthcare of Atlanta Inc Home health agency, Atlanta, GA, CCN 117067
  • Visiting Nurse Health System, Inc Home health agency, Marietta, GA, CCN 117000
  • Grady Memorial Hospital Hospital, Atlanta, GA, CCN 110079
  • Grady Memorial Hospital Inpatient rehabilitation facility, Atlanta, GA, CCN 11T079

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Medical Care Foundation Inc Current Accepting new patients
Emory Medical Care Foundation Inc Physical Medicine & Rehabilitation CurrentSince Jun 5, 2024 Accepting new patients
Emory Medical Care Foundation Inc CurrentSince Jun 5, 2024 Accepting new patients

Locations

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634515200000",
    "number": "1073045274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 PONCE DE LEON AVE STE. 300",
            "address_2": "#1635",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 GREEN ST",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753609",
            "telephone_number": "201-654-6397",
            "fax_number": "314-405-9284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN-MICHAILIDIS",
        "first_name": "EMILY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-28",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "GA",
            "license": "90254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

Verify at the official NPI Registry.