Individual provider Active NPI

Egidijus Kazlauskas, PA-C

  • Physician Assistant
  • Marietta, GA
National Provider Identifier
1689223604
Registry record updated Aug 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11008 Issued in GA
Practice address
55 Whitcher St NE Ste 160
Marietta, GA 30060-1160
Phone
(770) 590-4180
Fax
(770) 590-4186
NPI assigned
Sep 11, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-09457 NC
Medical Physician Assistant 363AM0700X 0010-09457 NC
Physician Assistant 363A00000X 11008 GA Primary

Addresses

Primary practice location

55 Whitcher St NE Ste 160
Marietta, GA 30060-1160

Mailing address

55 Whitcher St NE Ste 160
Marietta, GA 30060-1160
Phone (770) 590-4180

Other practice location 1

601 N Elm St
High Point, NC 27262-4331
Phone (336) 878-6000

Other practice location 2

1 Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2011

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ekazlauskas490097@directwellstar.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191114001097 NC Practitioner - Physician Assistant 1355773235
I20220607000510 GA Practitioner - Physician Assistant 1355773235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 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)

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 Hospital, Marietta, GA, CCN 110035

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
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Jun 1, 2022 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Jun 1, 2022 Accepting new patients

Locations

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

55 Whitcher St NE
Ste 160
Marietta, GA 30060
Phone (770) 590-4180

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

Organizations & group practices 3

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 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": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660867200000",
    "number": "1689223604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE STE 160",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601160",
            "telephone_number": "770-590-4180",
            "fax_number": "770-590-4186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE STE 160",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601160",
            "telephone_number": "770-590-4180",
            "fax_number": "770-590-4186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 N Elm St",
            "address_purpose": "LOCATION",
            "city": "High Point",
            "state": "NC",
            "postal_code": "272624331",
            "country_code": "US",
            "telephone_number": "336-878-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271570001",
            "country_code": "US",
            "telephone_number": "336-716-2011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAZLAUSKAS",
        "first_name": "EGIDIJUS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-11",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-09457",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-09457",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "11008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ekazlauskas490097@directwellstar.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "55 Whitcher St NE Ste 160",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300601160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.