Individual provider Active NPI

Kirk Bryant, PHD

  • Clinical Psychologist
  • Marietta, GA
National Provider Identifier
1114397585
Registry record updated Oct 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY004187 Issued in GA
Practice address
3939 Roswell Rd Ste 200
Marietta, GA 30062-6285
Phone
(470) 956-3940
NPI assigned
Sep 29, 2015
Last updated
Oct 31, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X
Clinical Psychologist 103TC0700X PSY004187 GA Primary

Addresses

Primary practice location

3939 Roswell Rd Ste 200
Marietta, GA 30062-6285

Mailing address

3939 Roswell Rd Ste 200
Marietta, GA 30062-6285
Phone (470) 956-3940

Other practice location 1

930 Chestnut Ridge Rd
Morgantown, WV 26505-2807
Phone (304) 293-5323

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kbryant169010@directwellstar.org

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180823001396 GA Practitioner - Clinical Psychologist 4981914983 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 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)

3939 Roswell Rd
Marietta, GA 30062-6285

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

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 Philosophy

State licenses

LicenseStateTypeSpecialty
PSY004187GAMDClinical Psychologist
1108WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Apr 16, 2018 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients

Locations

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

3939 Roswell Rd
Ste 200
Marietta, GA 30062
Phone (470) 956-3940

Interoperability endpoints

  • Direct secure messaging: kbryant169010@directwellstar.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1443484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572480000000",
    "number": "1114397585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3939 ROSWELL RD STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300626285",
            "telephone_number": "470-956-3940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 ROSWELL RD STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300626285",
            "telephone_number": "470-956-3940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "930 Chestnut Ridge Rd",
            "address_purpose": "LOCATION",
            "city": "Morgantown",
            "state": "WV",
            "postal_code": "265052807",
            "country_code": "US",
            "telephone_number": "304-293-5323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRYANT",
        "first_name": "KIRK",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-29",
        "last_updated": "2019-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY004187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbryant169010@directwellstar.org",
            "affiliation": "N",
            "address_1": "3939 Roswell Rd Ste 200",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300626285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.