Individual provider Active NPI

Mark E Kopel, PA

  • Anesthesiologist Assistant
  • Atlanta, GA
National Provider Identifier
1770520876
Registry record updated Sep 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
000479 Issued in GA
Practice address
303 Parkway Dr NE
PMB 404
Atlanta, GA 30312-1212
Phone
(404) 265-4520
Fax
(404) 265-3894
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 000479 GA Primary

Addresses

Primary practice location

303 Parkway Dr NE
PMB 404
Atlanta, GA 30312-1212

Mailing address

PO Box 932925
Atlanta, GA 31193-2925
Phone (800) 364-9216

Other identifiers 6

IdentifierTypeStateIssuer
100002072EMedicaidGA
1770520876OtherGANPI
100002072FMedicaidGA
P00194468OtherGARR MEDICARE
1982637419OtherGAGROUP NPI
N360028OtherGAWELLCARE MEDICAID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040520000456 GA Practitioner - Anesthesiology Assistant 5496746240 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 1979
Medicare assignment
May accept Medicare assignment
Group practices
Mak Anesthesia Holdings, LLCGroup PAC ID 4284917204, 370 clinicians

Practice addresses (Care Compare)

3000 Hospital Blvd
Roswell, GA 30076-4915
Phone (770) 751-2500

3950 Austell Rd
Austell, GA 30106-1121
Phone (770) 702-1806

Hospital & facility affiliations

  • Wellstar North Fulton Medical Center Hospital, Roswell, GA, CCN 110198

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts, Physician Assistant

State licenses

LicenseStateTypeSpecialty
000479GAMDClinical Social Worker
479GAMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Northlake Anesthesia Professionals, LLC CurrentSince Apr 1, 2004 Accepting new patients
Mak Anesthesia Holdings LLC CurrentSince Nov 14, 2018 Accepting new patients

Locations

303 Parkway Dr NE
Atlanta, GA 30312
Phone (404) 265-4000

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

601 S 8th St
Griffin, GA 30224
Phone (770) 228-2721

3000 Hospital Blvd
Roswell, GA 30076
Phone (770) 751-2500

4500 Hospital Blvd
Ste 210
Roswell, GA 30076

1491 Montreal Rd
Tucker, GA 30084
Phone (770) 270-1284

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 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": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222214400000",
    "number": "1770520876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932925",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311932925",
            "telephone_number": "800-364-9216",
            "fax_number": "423-892-5838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 PARKWAY DR NE",
            "address_2": "PMB 404",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121212",
            "telephone_number": "404-265-4520",
            "fax_number": "404-265-3894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPEL",
        "first_name": "MARK",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2008-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "000479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002072E",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1770520876",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002072F",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00194468",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1982637419",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE MEDICAID",
            "identifier": "N360028",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.