NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

  • Pediatric Anesthesiology Physician
  • Kennesaw, GA
National Provider Identifier
1972905396
Registry record updated Sep 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Anesthesiology PhysicianTaxonomy code 207LP3000X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Practice address
1180 Ernest W Barrett Pkwy NW
Suite 100
Kennesaw, GA 30144-4534
Phone
(770) 644-1274
Fax
(770) 644-1119
NPI assigned
Sep 17, 2014
Organization subpart
Yes
Parent organization
WELLSTAR MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 26, 2014

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

Authorized official

Name
Mrs. Nicole Ashe
Title
Executive Director of Finance
Phone
(470) 644-0095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP3000X GA Primary

Addresses

Primary practice location

1180 Ernest W Barrett Pkwy NW
Suite 100
Kennesaw, GA 30144-4534

Mailing address

1180 Ernest W Barrett Pkwy NW
Suite 100
Kennesaw, GA 30144-4534
Phone (770) 644-1274

Other names 1

  • WellStar Pediatric Anesthesia Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110127000374 GA Part B Supplier - Clinic/Group Practice 6709065402 Receives reassigned benefits from 4,219 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Wellstar Medical Group LLC125 organizations share this tax ID, including this one
Part of
Wellstar Medical Group LLC

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Locations

1180 Ernest W Barrett Pkwy NW
#100
Kennesaw, GA 30144
Phone (770) 644-1274

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411689600000",
    "number": "1972905396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 ERNEST W BARRETT PKWY NW",
            "address_2": "SUITE 100",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301444534",
            "telephone_number": "770-644-1274",
            "fax_number": "770-644-1119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 ERNEST W BARRETT PKWY NW",
            "address_2": "SUITE 100",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301444534",
            "telephone_number": "770-644-1274",
            "fax_number": "770-644-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2014-09-17",
        "last_updated": "2014-09-26",
        "status": "A",
        "authorized_official_last_name": "ASHE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "470-644-0095",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207LP3000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Pediatric Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.