Deidra Dyan Munsanto, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

12201 Highway 92 Ste D
Woodstock, GA 30188

Phone

(770) 517-4621

NPI assigned

Dec 15, 2010

Last updated

Nov 6, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Miss Deidra Dyan Johnson Former name

Electronic endpoints 1

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, 2010

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)

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Wellstar Medical Group, LLC

  dba WellStar Family Medicine ACW

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group
• Wellstar Medical Group, LLC

  dba WellStar Northwest Women's Care

  • Obstetrics & Gynecology Physician
  • Marietta, GA
  • NPI 1184920233
  NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• AMC/North Fulton Urgent Care #2 LLC

  dba MedPost Urgent Care - Buford Highway

  • Urgent Care Clinic/Center
  • Atlanta, GA
  • NPI 1376984633
  NPD (past)
• AMC/North Fulton Urgent Care 1 LLC

  dba MedPost Urgent Care - Stone Mountain

  • Urgent Care Clinic/Center
  • Stone Mountain, GA
  • NPI 1518380914
  NPD (past)

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

{
    "created_epoch": "1292371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572998400000",
    "number": "1235432170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 SANDY PLAINS ROAD",
            "address_2": "MEDICAL STAFF SERVICES",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300666340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12201 HIGHWAY 92 STE D",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "30188",
            "telephone_number": "770-517-4621"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1601 SW 89th St Ste E200",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731596380",
            "country_code": "US",
            "telephone_number": "405-702-4435",
            "fax_number": "405-702-4437",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1601 SW 89th St Ste E200",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731596380",
            "country_code": "US",
            "telephone_number": "405-702-4435",
            "fax_number": "405-702-4437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUNSANTO",
        "first_name": "DEIDRA",
        "middle_name": "DYAN",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-15",
        "last_updated": "2019-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1937",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmunsanto298945@directwellstar.org",
            "affiliation": "N",
            "address_1": "12201 Highway 92 Ste D",
            "city": "Woodstock",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301887141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DEIDRA",
            "last_name": "JOHNSON",
            "middle_name": "DYAN",
            "prefix": "MISS",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• MPD Consulting, Inc
• Keerthi Mulamalla, M.D.
• Rachael Darlene Mullins
• Daniel Mulloy
• Amber R Mumford
• Samyuktha N Muralidhara, MD
• Amy C Murphy, FNP
• Madeline Murphy, LMSW
• Bhavana V Mutha, PHARMACIST
• Myeyedr Optometry of Georgia, LLC (MyEyeDr.)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; 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.