NPIMap

Individual provider Active NPI

Michelle A Ross, M.D.

  • Diagnostic Radiology Physician
  • Conyers, GA
National Provider Identifier
1124006309
Registry record updated Jan 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
045603 Issued in GA
Practice address
1412 Milstead Ave NE
Conyers, GA 30012-3877
Phone
(770) 918-3000
NPI assigned
Jan 6, 2006
Last updated
Jan 9, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 045603 GA Primary

Addresses

Primary practice location

1412 Milstead Ave NE
Conyers, GA 30012-3877

Mailing address

PO Box 200096
Cartersville, GA 30120-9002
Phone (678) 905-7053

Other identifiers 1

IdentifierTypeStateIssuer
000826856AMedicaidGA

Other names 1

  • Michelle Shubin Former name

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
I20060511000052 GA Practitioner - Diagnostic Radiology 9436160058 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Wayne State University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Radiology Services P CGroup PAC ID 3577454024, 70 clinicians

Practice addresses (Care Compare)

960 Joe Frank Harris Pkwy SE
Cartersville, GA 30120-2129
Phone (770) 382-1530

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Radiology Services P C Diagnostic Radiology CurrentSince Oct 1, 2018 Accepting new patients
The Emory Clinic Inc Diagnostic Radiology CurrentSince Jan 1, 2014 Accepting new patients
City of Hope Medical Group of Georgia LLC Diagnostic Radiology CurrentSince Mar 5, 2013 Accepting new patients
Clinch County Hospital Authority CurrentSince Oct 5, 2013 Accepting new patients
Atlanta Radiology Consultants, PC Diagnostic Radiology Past Accepting new patients
Aylo Health, LLC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

960 Joe Frank Harris Pkwy SE
Cartersville, GA 30120
Phone (404) 554-2196

1412 Milstead Ave NE
Conyers, GA 30012
Phone (770) 918-3000

1050 Valdosta Hwy
Homerville, GA 31634
Phone (912) 383-6575

1266 Highway 515 S
Jasper, GA 30143
Phone (706) 301-5350

600 Celebrate Life Pkwy
Newnan, GA 30265
Phone (404) 844-8334

62742 Collections Ctr Dr
Chicago, IL 60693

Organizations & group practices 7

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 2

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": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546992000000",
    "number": "1124006309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200096",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301209002",
            "telephone_number": "678-905-7053",
            "fax_number": "678-905-7053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 MILSTEAD AVE NE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123877",
            "telephone_number": "770-918-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "MICHELLE",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-06",
        "last_updated": "2019-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "045603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000826856A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "SHUBIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Conyers, GA

Sources for this page

Verify at the official NPI Registry.