NPIMap

Individual provider Active NPI

Peter R Jungblut, MD

  • Internal Medicine Physician
  • Marietta, GA
National Provider Identifier
1104104686
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
069056 Issued in GA
Practice address
3747 Roswell Rd Ste 216
Marietta, GA 30062
Phone
(770) 973-2272
NPI assigned
Aug 1, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 069056 GA Primary

Addresses

Primary practice location

3747 Roswell Rd Ste 216
Marietta, GA 30062

Mailing address

3747 Roswell Rd Ste 216
Marietta, GA 30062-6227
Phone (770) 973-2272

Other practice location 1

805 Sandy Plains Rd
Marietta, GA 30066-6340
Phone (770) 792-5015

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pjungblut55846@directwellstar.org

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
I20130709000788 GA Practitioner - Internal Medicine 7113198631 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians

Practice addresses (Care Compare)

3747 Roswell Rd
Marietta, GA 30062-6227

390 Ernest W Barrett Pkwy NW
Kennesaw, GA 30144-4989
Phone (770) 426-9945

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

Hospital & facility affiliations

  • Wellstar Home Health, LLC Home health agency, Marietta, GA, CCN 117102
  • Central HH Care, an Amedisys Company Home health agency, Atlanta, GA, CCN 117039
  • Community Home Health, an Amedisys Company Home health agency, Woodstock, GA, CCN 117130
  • Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035
  • Wellstar North Fulton Medical Center Hospital, Roswell, GA, CCN 110198
  • Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143
  • Wellstar Windy Hill Hospital Long-term care hospital, Marietta, GA, CCN 112007

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
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
069056GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Jun 1, 2013 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Jun 1, 2013 Accepting new patients
Shore Family Medicine Ass Past Accepting new patients
Wellstar Cardiovascular Medicine, LLC Past Accepting new patients

Locations

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

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

805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616

3747 Roswell Rd
Ste 216
Marietta, GA 30062
Phone (770) 973-2272

Interoperability endpoints

  • Direct secure messaging: pjungblut55846@directwellstar.org

Organizations & group practices 5

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 7

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": "1312156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570579200000",
    "number": "1104104686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3747 ROSWELL RD STE 216",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300626227",
            "telephone_number": "770-973-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3747 ROSWELL RD STE 216",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30062",
            "telephone_number": "770-973-2272"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "805 Sandy Plains Rd",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300666340",
            "country_code": "US",
            "telephone_number": "770-792-5015",
            "fax_number": "770-792-1450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUNGBLUT",
        "first_name": "PETER",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-01",
        "last_updated": "2019-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "069056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pjungblut55846@directwellstar.org",
            "affiliation": "N",
            "address_1": "3747 Roswell Rd Ste 216",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300626227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.