NPIMap

Individual provider Active NPI

Stacey A O'Brien, MD

  • Family Medicine Physician
  • Woodstock, GA
National Provider Identifier
1164843389
Registry record updated Oct 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
73828 Issued in GA
Practice address
14205 Highway 92 Ste 105
Woodstock, GA 30188-7138
Phone
(678) 293-7854
NPI assigned
Dec 16, 2013
Last updated
Oct 2, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L.3872R AL
Family Medicine Physician 207Q00000X 73828 GA Primary

Addresses

Primary practice location

14205 Highway 92 Ste 105
Woodstock, GA 30188-7138

Mailing address

1240 Eagles Landing Pkwy
Suite 110
Stockbridge, GA 30281-5170
Phone (770) 389-3855

Other practice location 1

1240 Eagles Landing Pkwy
Suite 110
Stockbridge, GA 30281-5170
Phone (770) 389-3855

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sobrien293680@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
I20160824002915 GA Practitioner - Family Practice 5799916201 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
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)

14025 Hwy 92
Suite 105
Woodstock, GA 30188-7138
Phone (678) 293-7854

14205 Hwy 92
Woodstock, GA 30188-7138

145 N Medical Pkwy
Woodstock, GA 30189-7031
Phone (770) 592-3000

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

Hospital & facility affiliations

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 Medicine

State licenses

LicenseStateTypeSpecialty
L.3872RALMDFamily Medicine Physician
73828GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Dec 1, 2018 Accepting new patients
Wellstar Medical Group, LLC Family Medicine Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Dec 1, 2018 Accepting new patients
Aylo Health, LLC Family Medicine Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Aylo Health, LLC Family Medicine Past Accepting new patients
Aylo Health, LLC Past Accepting new patients

Locations

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

14205 Highway 92
Ste 105
Woodstock, GA 30188
Phone (678) 293-7854

Interoperability endpoints

  • Direct secure messaging: sobrien293680@directwellstar.org

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 5

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": "1387152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569974400000",
    "number": "1164843389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 EAGLES LANDING PKWY",
            "address_2": "SUITE 110",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815170",
            "telephone_number": "770-389-3855",
            "fax_number": "770-474-8078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14205 HIGHWAY 92 STE 105",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301887138",
            "telephone_number": "678-293-7854"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1240 Eagles Landing Pkwy",
            "address_2": "Suite 110",
            "address_purpose": "LOCATION",
            "city": "Stockbridge",
            "state": "GA",
            "postal_code": "302815170",
            "country_code": "US",
            "telephone_number": "770-389-3855",
            "fax_number": "770-474-8078",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "STACEY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-16",
        "last_updated": "2019-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "L.3872R",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "73828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sobrien293680@directwellstar.org",
            "affiliation": "N",
            "address_1": "14205 Highway 92 Ste 105",
            "city": "Woodstock",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301887138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Woodstock, GA

Sources for this page

Verify at the official NPI Registry.