NPIMap

Individual provider Active NPI

Sally M. Revell, MD

  • Otolaryngology Physician
  • Marietta, GA
National Provider Identifier
1225212061
Registry record updated Oct 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
65884 Issued in GA
Practice address
699 Church St NE
Ste 340
Marietta, GA 30060
Phone
(770) 793-7613
Fax
(770) 793-7413
NPI assigned
Dec 27, 2007
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 65884 GA Primary

Addresses

Primary practice location

699 Church St NE
Ste 340
Marietta, GA 30060

Mailing address

148 Bill Carruth Pkwy
Ste 220
Hiram, GA 30141-3754
Phone (770) 505-0023

Other names 1

  • Dr. Sally P Merryman Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address srevell26564@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
I20110908002190 GA Practitioner - Otolaryngology 6103096748 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Baylor College of Medicine, 2006
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)

699 Church Nest
Suite 340
Marietta, GA 30060-1131
Phone (770) 793-7613

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
65884GAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Sep 1, 2011 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Sep 1, 2011 Accepting new patients
Wellstar Cardiovascular Medicine, LLC Past Accepting new patients

Locations

148 Bill Carruth Pkwy
Ste 220
Hiram, GA 30141
Phone (770) 505-0023

5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230

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

699 Church St NE
Ste 340
Marietta, GA 30060
Phone (678) 355-1620

Interoperability endpoints

  • Direct secure messaging: srevell26564@directwellstar.org

Organizations & group practices 4

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 4

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": "1198713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569974400000",
    "number": "1225212061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 BILL CARRUTH PKWY",
            "address_2": "STE 220",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301413754",
            "telephone_number": "770-505-0023",
            "fax_number": "770-505-9848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "699 CHURCH ST NE",
            "address_2": "STE 340",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30060",
            "telephone_number": "770-793-7613",
            "fax_number": "770-793-7413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVELL",
        "first_name": "SALLY",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-27",
        "last_updated": "2019-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "65884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "srevell26564@directwellstar.org",
            "affiliation": "N",
            "address_1": "699 Church St NE",
            "address_2": "Ste 340",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "MERRYMAN",
            "middle_name": "P",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.