NPIMap

Organization Active NPI

Wellstar Cardiovascular Medicine, LLC

  • Cardiovascular Disease Physician
  • Woodstock, GA
National Provider Identifier
1811272693
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
120 Stonebridge Pkwy
Suite 110
Woodstock, GA 30189-3767
Phone
(678) 324-4400
Fax
(770) 528-9933
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 Physician 207RC0000X NU Primary
Clinical Cardiac Electrophysiology Physician 207RC0001X NU
Interventional Cardiology Physician 207RI0011X NU

Addresses

Primary practice location

120 Stonebridge Pkwy
Suite 110
Woodstock, GA 30189-3767

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
386693863AMedicaidGA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1082317Wellstar Cardiovascular Medicine120 Stonebridge Parkway, Suite 110, Woodstock, GA 30189Certificate of waiverApr 6, 2028

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.

Locations

120 Stonebridge Pkwy
Ste 110
Woodstock, GA 30189
Phone (678) 324-4400

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": "1811272693",
    "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": "770-528-9938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 STONEBRIDGE PKWY",
            "address_2": "SUITE 110",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301893767",
            "telephone_number": "678-324-4400",
            "fax_number": "770-528-9933"
        }
    ],
    "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": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "386693863A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, 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.
  • 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.