Individual provider Active NPI

Mark S Wyatt, MD

  • Surgery Physician
  • Austell, GA
National Provider Identifier
1245347194
Registry record updated Jun 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
032499 Issued in GA
Practice address
1700 Hospital South Dr
Suite 202
Austell, GA 30106-6810
Phone
(770) 944-7818
Fax
(770) 944-6402
NPI assigned
Aug 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 032499 GA Primary

Addresses

Primary practice location

1700 Hospital South Dr
Suite 202
Austell, GA 30106-6810

Mailing address

1700 Hospital South Dr
Suite 202
Austell, GA 30106-6810
Phone (770) 944-7818

Other identifiers 1

IdentifierTypeStateIssuer
000414939CMedicaidGA

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060330000583 GA Practitioner - General Surgery 3971535972 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Florida College of Medicine, 1986
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)

1700 Hospital S Dr
Austell, GA 30106-8116

3950 Austell Rd
Austell, GA 30106-1121
Phone (770) 732-4022

4441 Atlanta Rd SE
Smyrna, GA 30080-6443

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

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Aug 1, 2011 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Aug 1, 2011 Accepting new patients
Wellstar Medical Group, LLC Surgery Past Accepting new patients
Wellstar Atlanta General Surgery, LLC Surgery Past Accepting new patients

Locations

1700 Hospital South Dr
Ste 202
Austell, GA 30106
Phone (770) 793-7440

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

Interoperability endpoints

  • Direct secure messaging: mwyatt22921@directwellstar.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": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435276800000",
    "number": "1245347194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 HOSPITAL SOUTH DR",
            "address_2": "SUITE 202",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301066810",
            "telephone_number": "770-944-7818",
            "fax_number": "770-944-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 HOSPITAL SOUTH DR",
            "address_2": "SUITE 202",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301066810",
            "telephone_number": "770-944-7818",
            "fax_number": "770-944-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "MARK",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2015-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "032499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000414939C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austell, GA

Sources for this page

Verify at the official NPI Registry.