Individual provider Active NPI

Ryan Hudson Fitzgerald, DPM

  • Podiatrist
  • Canton, GA
National Provider Identifier
1760649602
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
POD001364 Issued in GA
Practice address
132 Riverstone Ter Ste 101
Canton, GA 30114
Phone
(678) 880-0036
Fax
(404) 481-4427
NPI assigned
May 19, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 626 SC
Foot & Ankle Surgery Podiatrist 213ES0103X 0103301013 VA
Podiatrist 213E00000X POD001364 GA Primary

Addresses

Primary practice location

132 Riverstone Ter Ste 101
Canton, GA 30114

Mailing address

900 Circle 75 Pkwy SE Ste 900
Atlanta, GA 30339-3084
Phone (678) 426-2171

Other practice location 1

355 Tower Rd NE Ste 103
Marietta, GA 30060-9410
Phone (770) 590-4188

Other identifiers 1

IdentifierTypeStateIssuer
PD6265MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rfitzgerald436535@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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180707000003 GA Practitioner - Podiatry 1557414273 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 2006
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)

2540 Windy Hill Rd
Marietta, GA 30067-8605
Phone (770) 644-1570

2540 Windy Hill Serd
Marietta, GA 30067-8605
Phone (770) 644-1274

2550 Windy Hill Rd SE
Suite 220
Marietta, GA 30067-8605
Phone (404) 321-9900

355 Tower Rd NE
Suite 103
Marietta, GA 30060-9410
Phone (770) 917-6795

4900 Ivey NWRD
Suite 1826
Acworth, GA 30101-4142
Phone (770) 975-9077

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

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10
Removal of nail tissue149
Removal or shaving of skin growth49
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
POD001364GAMDPodiatrist
0103301013VAMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Nov 15, 2021 Accepting new patients

Locations

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

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

355 Tower Rd NE
Ste 103
Marietta, GA 30060
Phone (770) 420-1690

Interoperability endpoints

  • Direct secure messaging: rfitzgerald@direct-address.org
  • Direct secure messaging: rfitzgerald@directaddress.net
  • Direct secure messaging: rfitzgerald436535@directwellstar.org

Organizations & group practices 2

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 4

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": "1211155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1760649602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 CIRCLE 75 PKWY SE STE 900",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303393084",
            "telephone_number": "678-426-2171",
            "fax_number": "404-446-1957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 RIVERSTONE TER STE 101",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "30114",
            "telephone_number": "678-880-0036",
            "fax_number": "404-481-4427"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "355 Tower Rd NE Ste 103",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300609410",
            "country_code": "US",
            "telephone_number": "770-590-4188",
            "fax_number": "770-590-4189",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "RYAN",
        "middle_name": "HUDSON",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-19",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "SC",
            "license": "626",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "VA",
            "license": "0103301013",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "GA",
            "license": "POD001364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PD6265",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rfitzgerald436535@directwellstar.org",
            "affiliation": "N",
            "address_1": "355 Tower Rd NE Ste 103",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300609410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

Verify at the official NPI Registry.