NPIMap

Individual provider Active NPI

Keerthi Mulamalla, M.D.

  • Family Medicine Physician
  • Woodstock, GA
National Provider Identifier
1992907760
Registry record updated Oct 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
69073 Issued in GA
Practice address
145 N Medical Pkwy
Woodstock, GA 30189-7031
Phone
(770) 592-3000
Fax
(770) 592-3075
NPI assigned
Jun 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R8013 IA
Family Medicine Physician 207Q00000X 69073 GA Primary

Addresses

Primary practice location

145 N Medical Pkwy
Woodstock, GA 30189-7031

Mailing address

145 N Medical Pkwy
Woodstock, GA 30189-7031
Phone (770) 592-3000

Other identifiers 1

IdentifierTypeStateIssuer
06601009OtherIAECFMG

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmulamalla56027@directwellstar.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130829000043 GA Practitioner - Family Practice 7911051131 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

1680 Hospital S Dr
Austell, GA 30106-8110
Phone (770) 422-1372

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
69073GAMDFamily Medicine Physician
R8013IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC Family Medicine CurrentSince Sep 1, 2013 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Sep 1, 2013 Accepting new patients

Locations

1680 Hospital South Dr
Austell, GA 30106
Phone (678) 945-2100

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

805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616

145 N Medical Pkwy
Woodstock, GA 30189
Phone (770) 517-1900

Organizations & group practices 2

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571097600000",
    "number": "1992907760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 N MEDICAL PKWY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301897031",
            "telephone_number": "770-592-3000",
            "fax_number": "770-592-3075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 N MEDICAL PKWY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301897031",
            "telephone_number": "770-592-3000",
            "fax_number": "770-592-3075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULAMALLA",
        "first_name": "KEERTHI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-04",
        "last_updated": "2019-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "R8013",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "69073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ECFMG",
            "identifier": "06601009",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmulamalla56027@directwellstar.org",
            "affiliation": "N",
            "address_1": "145 N Medical Pkwy",
            "city": "Woodstock",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301897031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Woodstock, GA

Sources for this page

Verify at the official NPI Registry.