Individual provider Active NPI

Michael Craig Fiedorek, MD

  • Pediatric Anesthesiology Physician
  • Atlanta, GA
National Provider Identifier
1225458342
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Anesthesiology PhysicianTaxonomy code 207LP3000X
License
83557 Issued in GA
Practice address
1405 Clifton Rd NE FL 3
Atlanta, GA 30322-1060
Phone
(404) 785-6670
Fax
(404) 785-1362
NPI assigned
Apr 17, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Anesthesiology Physician 207LP3000X 83557 GA Primary

Addresses

Primary practice location

1405 Clifton Rd NE FL 3
Atlanta, GA 30322-1060

Mailing address

1405 Clifton Rd NE FL 3
Atlanta, GA 30322-1060
Phone (404) 785-6670

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address choa@choa.gadirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, TN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211206000276 GA Practitioner - Anesthesiology 0941526487 Reassigns benefits to 1 organization
I20260522002136 TN Practitioner - Anesthesiology 0941526487 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

255 W Michigan Ave
Jackson, MI 49201-2218

850 Poplar Ave
BLDG 2
Memphis, TN 38105-4607

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Choa Multispecialty, LLC Current Accepting new patients
Choa Hospital Based, LLC Pediatric Anesthesiology CurrentSince Sep 1, 2021 Accepting new patients
Egleston Pediatric Group Current Accepting new patients

Locations

1405 Clifton Rd NE
Fl 3
Atlanta, GA 30322
Phone (404) 785-6670

1405 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 785-1112

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.

NPI Registry JSON

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

{
    "created_epoch": "1397692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1225458342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 CLIFTON RD NE FL 3",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221060",
            "telephone_number": "404-785-6670",
            "fax_number": "404-785-1362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 CLIFTON RD NE FL 3",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221060",
            "telephone_number": "404-785-6670",
            "fax_number": "404-785-1362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIEDOREK",
        "first_name": "MICHAEL",
        "middle_name": "CRAIG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-17",
        "last_updated": "2022-06-06",
        "certification_date": "2020-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "GA",
            "license": "83557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "choa@choa.gadirect.net",
            "affiliation": "N",
            "address_1": "1405 Clifton Rd NE Fl 3",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303221060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.