Active NPI
Wellstar Medical Group, LLC
- Multi-Specialty Clinic/Center
- Marietta, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- WELLSTAR MEDICAL GROUP, LLC
- Practice address
- 1800 Parkway PL SE
Marietta, GA 30067-8200 - Phone
- (470) 267-2433
- NPI assigned
- Feb 18, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Maxwell Kagan
- Title
- VP/Cfo
- Phone
- (470) 644-0065
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | GA | Primary |
Addresses
Primary practice location
1800 Parkway PL SE
Marietta, GA 30067-8200
Mailing address
PO Box 742322
Atlanta, GA 30374-2322
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA, SC
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110127000374 | GA | Part B Supplier - Clinic/Group Practice | 6709065402 |
Receives reassigned benefits from 4,219 practitioners This NPI is an additional NPI on the enrollment |
| O20230821000129 | SC | Part B Supplier - Clinic/Group Practice | 6709065402 |
Receives reassigned benefits from 59 practitioners Practice locations: North Augusta, SC; Edgefield, SC; Columbia, SC; Aiken, SC |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider DirectoryLocations (25 of 102)
1685 Mars Hill Rd NW
Ste 201
Acworth, GA 30101
Phone (678) 354-0455
4550 Cobb Parkway North NW
Ste 305
Acworth, GA 30101
Phone (770) 792-5275
4900 Ivey Rd NW
Ste 1320
Acworth, GA 30101
Phone (470) 267-0870
2450 Old Milton Pkwy
Ste LL1
Alpharetta, GA 30009
Phone (470) 267-0410
2570 Holcomb Bridge Rd
Ste 110
Alpharetta, GA 30022
Phone (770) 650-8980
2450 Old Milton Pkwy
Ste 101
Alpharetta, GA 30009
Phone (470) 267-0290
2450 Old Milton Pkwy
Ste 203
Alpharetta, GA 30009
Phone (470) 267-0380
3355 Cascade Rd SW
Ste 100
Atlanta, GA 30311
Phone (404) 691-2529
320 Parkway Dr NE
Ste 300
Atlanta, GA 30312
Phone (404) 265-6991
3730 Carmia Dr SW
Atlanta, GA 30331
Phone (404) 344-4136
2850 Paces Ferry Rd SE
#460470
Atlanta, GA 30339
Phone (678) 556-4950
229 Peachtree St NE
Ste 1200
Atlanta, GA 30303
Phone (404) 874-1788
3886 Princeton Lakes Way SW
Ste 120
Atlanta, GA 30331
Phone (302) 401-9193
141 Piedmont Ave NE
Ste D
Atlanta, GA 30303
Phone (404) 413-1930
285 Boulevard NE
Ste 545
Atlanta, GA 30312
Phone (404) 265-4400
699 Broad St
Ste 6000
Augusta, GA 30901
Phone (701) 721-6029
1220 W Wheeler Pkwy
Ste B
Augusta, GA 30909
Phone (706) 721-2741
2470 Wrightsboro Rd
Augusta, GA 30904
Phone (706) 481-6920
1220 W Wheeler Pkwy
Ste D
Augusta, GA 30909
1790 Mulkey Rd
#8A
Austell, GA 30106
Phone (770) 944-1830
1790 Mulkey Rd
Ste 8
Austell, GA 30106
Phone (770) 944-1830
1625 Hospital North Dr
Austell, GA 30106
Phone (770) 732-6950
1025 E West Connector
Ste 520
Austell, GA 30106
Phone (678) 273-3071
1790 Mulkey Rd
Ste 510
Austell, GA 30106
Phone (470) 267-2000
1700 Hospital South Dr
Ste 404
Austell, GA 30106
Phone (404) 645-8271
Interoperability endpoints
- adave63931@directwellstar.org
- sbaker21562@directwellstar.org
- hkrysiak62156@directwellstar.org
- enelson89043@directwellstar.org
- rjadick446195@directwellstar.org
- rtaylor135017@directwellstar.org
- mgentry25795@directwellstar.org
- ccharles350312@directwellstar.org
- gbahnson289325@directwellstar.org
- mjacobpintro22389@directwellstar.org
- amehta123309@directwellstar.org
- lmcdaniel127973@directwellstar.org
- jhurd376533@directwellstar.org
- jneuman376531@directwellstar.org
- ghathaway56266@directwellstar.org
- rmyung57923@directwellstar.org
- dshaffer61980@directwellstar.org
- mlyle32480@directwellstar.org
- bowens402041@directwellstar.org
- dlin434871@directwellstar.org
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| A G Rhodes Home Cobb Inc | Skilled nursing facility | Adp of the SNF | Jun 5, 2017 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
Practitioners & affiliated clinicians
Practitioners 4,420
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455753600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1730332800000",
"number": "1275992240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 742322",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303742322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 PARKWAY PL SE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300678200",
"telephone_number": "470-267-2433"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WELLSTAR MEDICAL GROUP, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2016-02-18",
"last_updated": "2024-10-31",
"certification_date": "2024-10-31",
"status": "A",
"authorized_official_last_name": "KAGAN",
"authorized_official_first_name": "MAXWELL",
"authorized_official_title_or_position": "VP/CFO",
"authorized_official_telephone_number": "470-644-0065",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": "GA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.1068.1",
"affiliationName": "Cobius Healthcare Solutions",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "2720 Dundee Rd # 302",
"city": "Northbrook",
"state": "IL",
"country_code": "US",
"postal_code": "600622609",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.