NPIMap

Individual provider Active NPI

Manolo Gallego, M.D.

  • Nephrology Physician
  • Marietta, GA
National Provider Identifier
1275520793
Registry record updated Mar 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
036745 Issued in GA
Practice address
880 Canton Rd NE
Suite 400
Marietta, GA 30060-7276
Phone
(770) 528-9788
Fax
(770) 420-2229
NPI assigned
Sep 30, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 22, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 036745 GA
Nephrology Physician 207RN0300X 036745 GA Primary

Addresses

Primary practice location

880 Canton Rd NE
Suite 400
Marietta, GA 30060-7276

Mailing address

880 Canton Rd NE
Suite 400
Marietta, GA 30060-7276
Phone (770) 528-9788

Other identifiers 3

IdentifierTypeStateIssuer
00691182FMedicaidGA
000691182ABMedicaidGA
00691182EMedicaidGA

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
I20050308000020 GA Practitioner - NephrologyPractitioner - Internal Medicine 1850345463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Georgia Kidney Specialists, LLCGroup PAC ID 8921044660, 4 clinicians

Practice addresses (Care Compare)

880 Canton Rd NE
Suite 400
Marietta, GA 30060-7283
Phone (770) 528-9788

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Georgia Kidney Specialists, LLC Nephrology CurrentSince Jul 1, 2005 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Usrc Woodstock, LLC PastSince Dec 31, 2018 Accepting new patients
Usrc Cobb County Dialysis, LLC PastSince Aug 1, 2021 Accepting new patients

Locations

20 Collins Dr
Ste A
Cartersville, GA 30120
Phone (770) 528-9788

880 Canton Rd NE
Ste 400
Marietta, GA 30060
Phone (770) 528-9788

Interoperability endpoints

  • Direct secure messaging: mgallego61972@directwellstar.org
  • Direct secure messaging: manolo.gallego@direct.davitaphysiciansolutions.com

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 6

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": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332374400000",
    "number": "1275520793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 CANTON RD NE",
            "address_2": "SUITE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607276",
            "telephone_number": "770-528-9788",
            "fax_number": "770-420-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 CANTON RD NE",
            "address_2": "SUITE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607276",
            "telephone_number": "770-528-9788",
            "fax_number": "770-420-2229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLEGO",
        "first_name": "MANOLO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2012-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "036745",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "036745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00691182F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000691182AB",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00691182E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.