Individual provider Active NPI

John Carmichael Ricketts, M.D.

  • Cardiovascular Disease Physician
  • Atlanta, GA
National Provider Identifier
1558780403
Registry record updated Jul 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
77864 Issued in GA
Practice address
1110 W Peachtree St NW Ste 920
Atlanta, GA 30309-3609
Phone
(404) 962-6000
Fax
(404) 962-6001
NPI assigned
Apr 8, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Cardiovascular Disease Physician 207RC0000X 77864 GA Primary

Addresses

Primary practice location

1110 W Peachtree St NW Ste 920
Atlanta, GA 30309-3609

Mailing address

1110 W Peachtree St NW Ste 920
Atlanta, GA 30309-3609
Phone (404) 962-6000

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
I20210722000087 GA Practitioner - Cardiovascular Disease (Cardiology) 1759631278 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of South Alabama College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Cardiovascular Professional Services, LLCGroup PAC ID 9739189838, 143 clinicians

Practice addresses (Care Compare)

6135 Barfield Rd
Suite 100
Sandy Springs, GA 30328-4308
Phone (678) 223-7928

Hospital & facility affiliations

  • Northside Hospital Hospital, Atlanta, GA, CCN 110161
  • Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087
  • Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Merit-based Incentive Payment System (MIPS)

Final score
77.82 of 100Reported as group
Quality
67.82
Promoting interoperability
77
Improvement activities
40
Cost
77.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
077864GAMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Cardiovascular Professional Services, LLC Cardiovascular Disease CurrentSince Jun 1, 2024 Accepting new patients

Locations

1110 W Peachtree St NW
Ste 920
Atlanta, GA 30309

1110 W Peachtree St NW
Ste 940
Atlanta, GA 30309
Phone (770) 292-3490

721 Wellness Way
Ste 210
Lawrenceville, GA 30046
Phone (678) 442-1161

1285 Upper Hembree Rd
Roswell, GA 30076
Phone (770) 343-8565

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

6135 Barfield Rd
Ste 200
Sandy Springs, GA 30328
Phone (404) 256-8500

1100 Johnson Fy Rd NE
Ste 180
Sandy Springs, GA 30342
Phone (404) 250-6691

6135 Barfield Rd
Ste 100
Sandy Springs, GA 30328

Organizations & group practices 1

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": "1396915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1558780403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 W PEACHTREE ST NW STE 920",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303093609",
            "telephone_number": "404-962-6000",
            "fax_number": "404-962-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 W PEACHTREE ST NW STE 920",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303093609",
            "telephone_number": "404-962-6000",
            "fax_number": "404-962-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICKETTS",
        "first_name": "JOHN",
        "middle_name": "CARMICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-08",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "77864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.