Individual provider Active NPI

Ryan Gibson

  • Hospitalist Physician
  • Marietta, GA
National Provider Identifier
1689137622
Registry record updated Aug 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
93191 Issued in GA
Practice address
677 Church St NE Lowr Level
Marietta, GA 30060-1101
Phone
(770) 793-5186
NPI assigned
Apr 8, 2019
Last updated
Aug 7, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2025

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
Hospitalist Physician 208M00000X 93191 GA Primary

Addresses

Primary practice location

677 Church St NE Lowr Level
Marietta, GA 30060-1101

Mailing address

677 Church St NE Lowr Level
Marietta, GA 30060-1101

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
I20220911000047 GA Practitioner - HospitalistPractitioner - Internal Medicine 4385979004 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Nova Southeastern College of Osteo Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

1510 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 845-3905

1514 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 880-7222

3000 Hospital Blvd
Roswell, GA 30076-4915
Phone (770) 751-2912

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

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 Osteopathy

State licenses

LicenseStateTypeSpecialty
11246GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Sep 1, 2022 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Sep 1, 2022 Accepting new patients
West Georgia Medical Center, Inc. Past Accepting new patients

Locations

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

677 Church St NE
Lowr
Marietta, GA 30060
Phone (470) 956-2020

805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616

Interoperability endpoints

  • Direct secure messaging: rgibson335969@directwellstar.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1554681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754524800000",
    "number": "1689137622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "677 CHURCH ST NE LOWR LEVEL",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 CHURCH ST NE LOWR LEVEL",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601101",
            "telephone_number": "770-793-5186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-08",
        "last_updated": "2025-08-07",
        "certification_date": "2025-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "93191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.