NPIMap

Organization Active NPI

Wellstar Cardiovascular Medicine, LLC

  • Cardiovascular Disease Physician
  • Acworth, GA
National Provider Identifier
1770868531
Registry record updated May 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
WELLSTAR CARDIOVASCULAR MEDICINE, LLC
Practice address
4900 Ivey Rd NW
BLDG 1800 Suite 1801
Acworth, GA 30101-4001
Phone
(770) 974-8479
Fax
(770) 974-8710
NPI assigned
Oct 12, 2011
Last updated
May 9, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLSTAR HEALTH SYSTEM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 9, 2012

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

Authorized official

Name
Dr. Barry D MangelNPI 1801863931
Title
Chief Cardiology Officer
Phone
(770) 424-6893

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary
Clinical Cardiac Electrophysiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0001X
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X

Addresses

Primary practice location

4900 Ivey Rd NW
BLDG 1800 Suite 1801
Acworth, GA 30101-4001

Mailing address

55 Whitcher St NE
Suite 350
Marietta, GA 30060-1155
Phone (770) 424-6893

Other identifiers 1

IdentifierTypeStateIssuer
386693863AMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Wellstar Cardiovascular Medicine LLC11 organizations share this tax ID, including this one
Part of
Wellstar Behavioral Hea

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336521600000",
    "number": "1770868531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE",
            "address_2": "SUITE 350",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601155",
            "telephone_number": "770-424-6893",
            "fax_number": "770-582-9938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 IVEY RD NW",
            "address_2": "BLDG 1800 SUITE 1801",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301014001",
            "telephone_number": "770-974-8479",
            "fax_number": "770-974-8710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR CARDIOVASCULAR MEDICINE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR HEALTH SYSTEM, INC.",
        "enumeration_date": "2011-10-12",
        "last_updated": "2012-05-09",
        "status": "A",
        "authorized_official_last_name": "MANGEL",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF CARDIOLOGY OFFICER",
        "authorized_official_telephone_number": "770-424-6893",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "386693863A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Acworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.