Individual provider Active NPI

Michael Vincent Santotome Mendoza, M.D

  • Neurocritical Care Physician
  • Atlanta, GA
National Provider Identifier
1265745491
Registry record updated Sep 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurocritical Care PhysicianTaxonomy code 2084A2900X
License
073365 Issued in GA
Practice address
285 Boulevard NE Ste 415
Atlanta, GA 30312-4210
Phone
(404) 265-4400
Fax
(404) 265-4452
NPI assigned
Jul 16, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 073365 GA
Clinical Neurophysiology Physician 2084N0600X 073365 GA
Neurocritical Care Physician 2084A2900X 073365 GA Primary

Addresses

Primary practice location

285 Boulevard NE Ste 415
Atlanta, GA 30312-4210

Mailing address

285 Boulevard NE
Suite 415
Atlanta, GA 30312
Phone (404) 265-4400

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
I20170703001134 GA Practitioner - Neurology 6406125632 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 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)

303 Pkwy Dr NE
Atlanta, GA 30312-1212
Phone (404) 265-4000

Hospital & facility affiliations

  • Wellstar North Fulton Medical Center Hospital, Roswell, GA, CCN 110198
  • Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035
  • Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143

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
073365GAMDNeurocritical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC Neurology CurrentSince Jul 10, 2017 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Jul 10, 2017 Accepting new patients
Wellstar North Fulton Hospital, Inc Past Accepting new patients

Locations

285 Boulevard NE
Ste 415
Atlanta, GA 30312
Phone (404) 265-4400

303 Parkway Dr NE
Atlanta, GA 30312
Phone (404) 265-4000

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: mmendoza140660@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 3

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": "1279238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504742400000",
    "number": "1265745491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 BOULEVARD NE",
            "address_2": "SUITE 415",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30312",
            "telephone_number": "404-265-4400",
            "fax_number": "404-265-4452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 BOULEVARD NE STE 415",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303124210",
            "telephone_number": "404-265-4400",
            "fax_number": "404-265-4452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "MICHAEL VINCENT",
        "middle_name": "SANTOTOME",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-16",
        "last_updated": "2017-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "073365",
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "GA",
            "license": "073365",
            "primary": false
        },
        {
            "code": "2084A2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurocritical Care",
            "state": "GA",
            "license": "073365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.