Individual provider Active NPI

William Broyles, MD

  • Family Medicine Physician
  • Kennesaw, GA
National Provider Identifier
1700960424
Registry record updated May 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
84545 Issued in GA
Practice address
3805 Cherokee St NW
Kennesaw, GA 30144-2085
Phone
(770) 426-5665
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 31453 NC
Family Medicine Physician 207Q00000X 84545 GA Primary

Addresses

Primary practice location

3805 Cherokee St NW
Kennesaw, GA 30144-2085

Mailing address

3805 Cherokee St NW Ste D
Kennesaw, GA 30144-2085
Phone (770) 426-5665

Other practice location 1

2100 Erwin Rd
Duke Univ Med Center
Durham, NC 27710
Phone (919) 620-4467

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wbroyles357216@directwellstar.org

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
I20200113001943 GA Practitioner - Family Practice 6901841915 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1986
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)

120 Greystone Power Blvd
Dallas, GA 30157-8297

1550 Kennesaw Due W Rd NW
Kennesaw, GA 30152-4338

3747 Roswell Rd
Marietta, GA 30062-6227

3980 Jiles Rd NW
Kennesaw, GA 30144-1109
Phone (678) 504-0100

4477 Towne Lake Pkwy
Suite 130
Woodstock, GA 30189-6720
Phone (770) 249-5620

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 Medicine

State licenses

LicenseStateTypeSpecialty
84545GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC Family Medicine Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Jan 1, 2020 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Jan 1, 2020 Accepting new patients

Locations

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

3805 Cherokee St NW
Kennesaw, GA 30144
Phone (770) 426-5665

3805 Cherokee St NW
Ste D
Kennesaw, GA 30144

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 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": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590105600000",
    "number": "1700960424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3805 CHEROKEE ST NW STE D",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301442085",
            "telephone_number": "770-426-5665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 CHEROKEE ST NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301442085",
            "telephone_number": "770-426-5665"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 Erwin Rd",
            "address_2": "Duke Univ Med Center",
            "address_purpose": "LOCATION",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27710",
            "country_code": "US",
            "telephone_number": "919-620-4467",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROYLES",
        "first_name": "WILLIAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "31453",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "84545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wbroyles357216@directwellstar.org",
            "affiliation": "N",
            "address_1": "3805 Cherokee St NW",
            "city": "Kennesaw",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301442085",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

Verify at the official NPI Registry.