MYSTIC MEDICAL, LLC
NPI 1093108763
Podiatrist - Foot & Ankle Surgery in Atlanta, GA
About Mystic Medical, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MYSTIC MEDICAL, LLC (NPI 1093108763) is a healthcare organization registered as a foot & ankle surgery in Atlanta, Georgia and active in the NPI registry since March 2015. The organization lists Amanda Dykes, Admin, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Group Practice 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mystic Medical, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
9Medicare enrollment records show 9 clinicians reassign Medicare billing to Mystic Medical, LLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (9)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mystic Medical, LLC's NPI number?
The NPI number for Mystic Medical, LLC is 1093108763. It was assigned to this organization in the NPPES registry on March 5, 2015.
Where is Mystic Medical, LLC located?
Mystic Medical, LLC is located at 5555 Glenridge Connector Suite 200, Atlanta, GA 30342. The listed phone number is (404) 351-0055.
What is Mystic Medical, LLC's specialty?
The primary specialty registered for this NPI is Podiatrist, specializing in Foot & Ankle Surgery, with taxonomy code 213ES0103X.
Is Mystic Medical, LLC enrolled in Medicare?
Yes. Mystic Medical, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Mystic Medical, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 9 clinicians in 2 Medicare specialties reassign their Medicare billing to Mystic Medical, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Podiatry (5) and Optometry (4). Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Mystic Medical, LLC accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Mystic Medical, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Mystic Medical, LLC was last updated on March 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mystic Medical, Llc · NPI 1093108763
Foot & Ankle Surgery organization in Atlanta, Georgia. Organization record, active in the CMS NPPES registry since March 5, 2015.
## Identity
- **NPI:** 1093108763 (Entity type: Organization)
- **Enumerated:** March 5, 2015
- **Primary specialty:** Podiatrist - Foot & Ankle Surgery · taxonomy 213ES0103X
- **Organization subpart:** No
- **Authorized official:** Amanda Dykes, ADMIN
## Practice location
- **Address:** 5555 GLENRIDGE CONNECTOR, SUITE 200, Atlanta, GA 30342-4759
- **Phone:** (404) 351-0055
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 9 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Podiatry (5), Optometry (4); 1 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 25, 2025
---
Source: [NPI Profile](https://npiprofile.com/npi/1093108763) · Data from the CMS NPPES public registry.