Kellie Elise Wydrinski, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12383 Issued in GA

Practice address

980 Johnson Ferry Rd Ste 820
Atlanta, GA 30342-1608

Phone

(404) 252-9307

Fax

(404) 252-5839

NPI assigned

May 4, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aga Professional Services LLCGroup PAC ID 3870768997, 175 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087
• Northside Hospital Hospital, Atlanta, GA, CCN 110161
• Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005
• Emory University Hospital Midtown Hospital, Atlanta, GA, CCN 110078
• Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kellie.wydrinski@ud.eclinicaldirectplus.com

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.

• Aga Professional Services, LLC

  • Gastroenterology Physician
  • Atlanta, GA
  • NPI 1063799120
  Medicare reassignment Care Compare group
• Aga Clinical Services, LLC

  • Gastroenterology Physician
  • Atlanta, GA
  • NPI 1295193399
  Medicare reassignment NPD
• Aga, LLC

  • Gastroenterology Physician
  • Atlanta, GA
  • NPI 1124064118
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Crawford Long Hospital

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1144203563
  Care Compare affiliation
• Kennestone Hospital, Inc.

  • General Acute Care Hospital
  • Marietta, GA
  • NPI 1649248626
  Care Compare affiliation
• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Cumming, GA
  • NPI 1376574277
  Care Compare affiliation
• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1457396079
  Care Compare affiliation
• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Lawrenceville, GA
  • NPI 1952340994
  Care Compare affiliation

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

{
    "created_epoch": "1714780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1184471377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 JOHNSON FERRY RD STE 820",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421608",
            "telephone_number": "404-252-9307",
            "fax_number": "404-252-5839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 JOHNSON FERRY RD STE 820",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421608",
            "telephone_number": "404-252-9307",
            "fax_number": "404-252-5839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYDRINSKI",
        "first_name": "KELLIE",
        "middle_name": "ELISE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-04",
        "last_updated": "2024-07-12",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ginny Wurttemberg, CNM, MSN
• Wwltach LLC
• Juanita D Wyatt-Hathaway, M.D.
• Glenn Wyatt III, RBT
• Rochelle Wyche
• John Bradley Wyly, M.D.
• Sarah Ann Wyman, ACNP
• Stephanie Nicole Wyman
• Maria Szczepanski Wynens
• Dana Wyner, PH.D.

• Physician Assistant in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.