Individual provider Active NPI

Michael John Koriwchak, M.D.

  • Otolaryngology Physician
  • Atlanta, GA
National Provider Identifier
1720085756
Registry record updated Feb 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
040130 Issued in GA
Practice address
5673 Peachtree Dunwoody Rd
Ste 150
Atlanta, GA 30342-1731
Phone
(404) 297-1780
Fax
(404) 252-7255
NPI assigned
Jul 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 040130 GA Primary
Sleep Medicine (Otolaryngology) Physician 207YS0012X 040130 GA

Addresses

Primary practice location

5673 Peachtree Dunwoody Rd
Ste 150
Atlanta, GA 30342-1731

Mailing address

5673 Peachtree Dunwoody Rd
Ste 150
Atlanta, GA 30342-1731
Phone (404) 297-1780

Other identifiers 4

IdentifierTypeStateIssuer
00663935AFMedicaidGA
5576015OtherGAAETNA
52448442OtherGABCBS OF GEORGIA
8306705OtherGACIGNA

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
I20040816001234 GA Practitioner - Otolaryngology 6002889284 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Duke University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
ENT of Georgia, LLCGroup PAC ID 1557254109, 12 clinicians
Georgia Surgical Professional Services LLCGroup PAC ID 3375774011, 38 clinicians

Practice addresses (Care Compare)

5673 Peachtree Dunwoody Rd
Suite 150
Atlanta, GA 30342-1771
Phone (404) 297-4230

748 Old Norcross Rd
Suite 100
Lawrenceville, GA 30046-3394
Phone (770) 339-1500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
040130GAMDSleep Medicine (Otolaryngology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Surgical Professional Services, LLC Otolaryngology CurrentSince Mar 1, 2014 Accepting new patients
ENT of Georgia, LLC Otolaryngology CurrentSince Sep 1, 1997 Accepting new patients
North Atlanta Scan Associates Inc Past Accepting new patients

Locations

550 Peachtree St NE
Ste 1640
Atlanta, GA 30308
Phone (404) 653-0830

748 Old Norcross Rd
Ste 100
Lawrenceville, GA 30046
Phone (404) 297-4230

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

5673 Peachtree Dunwoody Rd
Ste 150
Sandy Springs, GA 30342
Phone (404) 297-4230

1790 Presidential Cir
Ste A
Snellville, GA 30078
Phone (404) 297-4230

Interoperability endpoints

  • Direct secure messaging: mkoriwchak@entofga.emadirect.md

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": "1120608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485907200000",
    "number": "1720085756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5673 PEACHTREE DUNWOODY RD",
            "address_2": "STE 150",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421731",
            "telephone_number": "404-297-1780",
            "fax_number": "404-252-7255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5673 PEACHTREE DUNWOODY RD",
            "address_2": "STE 150",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421731",
            "telephone_number": "404-297-1780",
            "fax_number": "404-252-7255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORIWCHAK",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-06",
        "last_updated": "2017-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "040130",
            "primary": true
        },
        {
            "code": "207YS0012X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Sleep Medicine",
            "state": "GA",
            "license": "040130",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00663935AF",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5576015",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF GEORGIA",
            "identifier": "52448442",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "8306705",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.