NPIMap

Organization Active NPI

Westside Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Douglas, GA
National Provider Identifier
1013158948
Registry record updated Jul 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
WESTSIDE SURGERY CENTER, LLC
Practice address
314 Westside Drive
Douglas, GA 31533-0314
Phone
(912) 384-2200
Fax
(912) 383-7992
NPI assigned
Mar 24, 2009
Last updated
Jul 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2020

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

Authorized official

Name
Mrs. Amber Patterson
Title
Administrator
Phone
(912) 384-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

314 Westside Drive
Douglas, GA 31533-0314

Mailing address

P.O. Box 1068
Douglas, GA 31533-1068
Phone (912) 384-2200

Other identifiers 1

IdentifierTypeStateIssuer
794275173AMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091027000453 GA Part B Supplier - Ambulatory Surgical Center 8224175062 Receives reassigned benefits from 3 practitioners
Practice locations: Douglas, GA

National Provider Directory

National Provider Directory

Locations

310 Westside Dr
Douglas, GA 31533

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1237852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594857600000",
    "number": "1013158948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1068",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315331068",
            "telephone_number": "912-384-2200",
            "fax_number": "912-383-7992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 WESTSIDE DRIVE",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315330314",
            "telephone_number": "912-384-2200",
            "fax_number": "912-383-7992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-24",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "912-384-2200",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "794275173A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; 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.