Individual provider Active NPI

Serena Shah Frye, PA-C

  • Physician Assistant
  • Marietta, GA
National Provider Identifier
1194243899
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9829 Issued in GA
Practice address
55 Whitcher St NE Ste 160
Marietta, GA 30060-1160
Phone
(770) 590-4180
Fax
(770) 590-4186
NPI assigned
Sep 1, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 306999 LA
Physician Assistant 363A00000X 9829 GA Primary

Addresses

Primary practice location

55 Whitcher St NE Ste 160
Marietta, GA 30060-1160

Mailing address

55 Whitcher St NE Ste 160
Marietta, GA 30060-1160

Other practice location 1

2751 Albert L Bicknell Dr Ste 5C
Shreveport, LA 71103-3943
Phone (318) 227-9777

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sfrye531266@directwellstar.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20171004001803 LA Practitioner - Physician Assistant 3577838374 Reassigns benefits to 1 organization
I20200921000975 GA Practitioner - Physician Assistant 3577838374 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
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)

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

625 Church Nest
Marietta, GA 30060-1101
Phone (770) 422-2004

677 Church Nest
Marietta, GA 30060-1101

677 Church St NE
Suite 100P
Marietta, GA 30060-1101
Phone (470) 793-8585

Hospital & facility affiliations

  • Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9829GAMDPhysician Assistant
306999LAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Emory Clinic Inc CurrentSince Aug 10, 2020 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Sep 15, 2023 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Sep 15, 2023 Accepting new patients

Locations

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

101 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 778-4889

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

55 Whitcher St NE
Ste 160
Marietta, GA 30060
Phone (770) 590-4180

Interoperability endpoints

  • Direct secure messaging: sfrye39258@direct.emory.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 1

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": "1504224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1194243899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE STE 160",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE STE 160",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601160",
            "telephone_number": "770-590-4180",
            "fax_number": "770-590-4186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2751 Albert L Bicknell Dr Ste 5C",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711033943",
            "country_code": "US",
            "telephone_number": "318-227-9777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FRYE",
        "first_name": "SERENA",
        "middle_name": "SHAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-01",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "LA",
            "license": "306999",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "9829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sfrye531266@directwellstar.org",
            "affiliation": "N",
            "address_1": "55 Whitcher St NE Ste 160",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300601160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.