John Mark Lidell, M.M.SC. , PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

002952 Issued in GA

Practice address

101 Regency Park Dr Ste 110
McDonough, GA 30253-7076

Phone

(404) 996-0126

Fax

(678) 432-2626

NPI assigned

Dec 7, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1996

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)

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group
• Wellstreet of Georgia PC

  • Urgent Care Clinic/Center
  • Newnan, GA
  • NPI 1235411547
  Medicare reassignment
• Wellstar Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Austell, GA
  • NPI 1013213651
  NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Brightpoint Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Stockbridge, GA
  • NPI 1508915919
  NPD (past)
• Piedmont Providers LLC

  • Internal Medicine Physician
  • Jasper, GA
  • NPI 1548273592
  NPD (past)

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1962487538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3576 HIGHWAY 138 SE",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817909",
            "telephone_number": "770-474-7448",
            "fax_number": "770-474-7194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 REGENCY PARK DR STE 110",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302537076",
            "telephone_number": "404-996-0126",
            "fax_number": "678-432-2626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "913 Eagles Landing Pkwy Ste 150",
            "address_purpose": "LOCATION",
            "city": "Stockbridge",
            "state": "GA",
            "postal_code": "302815011",
            "country_code": "US",
            "telephone_number": "770-692-5910",
            "fax_number": "770-692-5916",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3576 Highway 138 SE",
            "address_purpose": "LOCATION",
            "city": "Stockbridge",
            "state": "GA",
            "postal_code": "302817909",
            "country_code": "US",
            "telephone_number": "770-474-7448",
            "fax_number": "770-474-7194",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIDELL",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "name_prefix": "Prof.",
        "credential": "M.M.SC. , PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "002952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlidell425648@directwellstar.org",
            "affiliation": "N",
            "address_1": "3576 Highway 138 SE",
            "city": "Stockbridge",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302817909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rachelle Levy, PT, DPT
• Anika Lewis-Clarke
• Karen Lewis, LPC
• Kendra Asantewaa Lewis, PHARMD
• Stacie S Lewis, NP
• Life Medical Supplies LLC
• Catherine Lindsey
• Tanesha Yolanda Lindsey, BSN, MSN
• Aniya Link
• Alexis Lissmore

• Physician Assistant in McDonough, GA
• Providers in McDonough, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; 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.

Verify at the official NPI Registry.