Active NPI
Ryan Edward Breshears, PH.D.
- Psychologist
- Marietta, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 55 Whitcher St NE
Suite 420
Marietta, GA 30060-1155 - Phone
- (770) 514-6760
- Fax
- (770) 794-8034
- NPI assigned
- Apr 27, 2008
- Last updated
- Oct 31, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | NU | Primary |
Addresses
Primary practice location
55 Whitcher St NE
Suite 420
Marietta, GA 30060-1155
Mailing address
55 Whitcher St NE
Suite 420
Marietta, GA 30060-1155
Phone (770) 514-6760
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY003306 | Other | GA | GA LICENSE # |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rbreshears7087@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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
355 Tower Rd NE
Suite 203
Marietta, GA 30060-9413
Phone (470) 267-1580
5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.93 of 100
- Quality
- 82.14
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstar Medical Group, LLC | Current | Accepting new patients | |
| Wellstar Medical Group, LLC | Current | Accepting new patients | |
| Wellstar Psychiatry, LLC | Past | Accepting new patients | |
| Wellstar Medical Group, LLC | Past | Accepting new patients |
Locations
5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230
5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222
2540 Windy Hill Rd SE
Marietta, GA 30067
Phone (470) 644-1274
55 Whitcher St NE
Ste 420
Marietta, GA 30060
Phone (770) 514-6760
Interoperability endpoints
- rbreshears7087@directwellstar.org
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba WellStar Family Medicine ACW
- Family Medicine Physician
- Kennesaw, GA
- NPI 1558664003
-
- Multi-Specialty Clinic/Center
- Marietta, GA
- NPI 1275992240
-
dba WellStar Psychiatry
- Psychiatry Physician
- Marietta, GA
- NPI 1629361605
-
- Psychiatry Physician
- Marietta, GA
- NPI 1619921376
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572480000000",
"number": "1922273358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 WHITCHER ST NE",
"address_2": "SUITE 420",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300601155",
"telephone_number": "770-514-6760",
"fax_number": "770-794-8034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 WHITCHER ST NE",
"address_2": "SUITE 420",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300601155",
"telephone_number": "770-514-6760",
"fax_number": "770-794-8034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRESHEARS",
"first_name": "RYAN",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-27",
"last_updated": "2019-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GA LICENSE #",
"identifier": "PSY003306",
"state": "GA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rbreshears7087@directwellstar.org",
"affiliation": "N",
"address_1": "55 Whitcher St NE",
"address_2": "Suite 420",
"city": "Marietta",
"state": "GA",
"country_code": "US",
"postal_code": "300601155",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.