Active NPI
Keegan Tupchong, M.D.
- Critical Care Medicine (Internal Medicine) Physician
- Marietta, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Medicine (Internal Medicine) Physician
- License
- 88879
- Practice address
- 400 Tower Rd NE Ste 200
Marietta, GA 30060-9412 - Phone
- (770) 422-1372
- Fax
- (770) 999-2488
- NPI assigned
- Jun 18, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 271412 | NY | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | 88879 | GA | Primary |
Addresses
Primary practice location
400 Tower Rd NE Ste 200
Marietta, GA 30060-9412
Mailing address
400 Tower Rd NE Ste 200
Marietta, GA 30060-9412
Phone (770) 422-1372
Other practice location 1
550 1st Ave
New York, NY 10016-6402
Phone (212) 263-5506
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ktupchong420818@directwellstar.org | Health Information Exchange (HIE) |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Critical Care (Intensivists)
- Education
- Jefferson Medical College of Thomas Jefferson University, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3950 Austell Rd
Austell, GA 30106-1121
Phone (770) 732-4022
5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222
625 Church Nest
Marietta, GA 30060-1101
Phone (770) 422-2004
677 Church Nest
Marietta, GA 30060-1101
677 Church St NE
Suite 100P
Marietta, GA 30060-1101
Phone (470) 793-8585
Hospital & facility affiliations
- Wellstar Kennestone Regional Medical Center
- Wellstar Cobb Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.93 of 100
- 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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstar Medical Group, LLC | Current | Accepting new patients | |
| Wellstar Medical Group, LLC | Current | Accepting new patients |
Locations
5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222
400 Tower Rd NE
Ste 200
Marietta, GA 30060
Phone (770) 514-7550
805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Kennesaw, GA
- NPI 1558664003
-
- Multi-Specialty Clinic/Center
- Marietta, GA
- NPI 1275992240
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Austell, GA
- NPI 1467420448
-
- General Acute Care Hospital
- Marietta, GA
- NPI 1649248626
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631145600000",
"number": "1346535226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 TOWER RD NE STE 200",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300609412",
"telephone_number": "770-422-1372",
"fax_number": "770-999-2488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 TOWER RD NE STE 200",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300609412",
"telephone_number": "770-422-1372",
"fax_number": "770-999-2488"
}
],
"practiceLocations": [
{
"address_1": "550 1st Ave",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "100166402",
"country_code": "US",
"telephone_number": "212-263-5506",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TUPCHONG",
"first_name": "KEEGAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-18",
"last_updated": "2021-09-09",
"certification_date": "2021-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NY",
"license": "271412",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "GA",
"license": "88879",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ktupchong420818@directwellstar.org",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"address_1": "400 Tower Rd NE Ste 200",
"city": "Marietta",
"state": "GA",
"country_code": "US",
"postal_code": "300609412",
"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 Sep 9, 2021; 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.