Samuel A Mickelson, MD

Primary specialty

Sleep Medicine (Otolaryngology) PhysicianTaxonomy code 207YS0012X

License

041173 Issued in GA

Practice address

960 Johnson Ferry Rd
Suite 200
Atlanta, GA 30342

Phone

(404) 943-0900

Fax

(404) 943-1390

NPI assigned

May 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Samuel Alan Mickelson Other name

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

Specialty

OtolaryngologyAlso: Sleep Medicine

Education

University of Michigan Medical School, 1982

Medicare assignment

May accept Medicare assignment

Group practices

Advanced Ear Nose and Throat Associates PCGroup PAC ID 2860443322, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Hospital, Atlanta, GA, CCN 110161

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: smickelson2763@choa.gadirect.net
• Direct secure messaging: sam.mickelson@397.chartlogic.direct-ci.com

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.

• Advanced Ear Nose and Throat Associates PC

  • Otolaryngology Physician
  • Atlanta, GA
  • NPI 1073655882
  Medicare reassignment Care Compare group NPD
• Advanced Sleep Laboratory-Dunwoody

  • Sleep Disorder Diagnostic Clinic/Center
  • Atlanta, GA
  • NPI 1477625051
  NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1457396079
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211500800000",
    "number": "1467410977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD",
            "address_2": "SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30342",
            "telephone_number": "404-943-0900",
            "fax_number": "404-943-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD",
            "address_2": "SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30342",
            "telephone_number": "404-943-0900",
            "fax_number": "404-943-1390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "SAMUEL",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2008-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "041173",
            "primary": false
        },
        {
            "code": "207YS0012X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Sleep Medicine",
            "state": "GA",
            "license": "041173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMUEL",
            "last_name": "MICKELSON",
            "middle_name": "ALAN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nichole Michelson, MA
• Jonathan Micieli, MD
• Katie Brewer Mick
• Nguyen L Mick, MS, RDN, LD
• Geoffrey Edward Mickells, M.D.
• Jadella Amanda Mickler, AGACNP-BC
• Jamaya Mickles
• Jeannel Tan Miclat
• Micromed LLC
• Mid Physician Network (in), LLC

• Otolaryngology Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Otolaryngology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; 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.

Verify at the official NPI Registry.