ASC of Baucom & Mina Derm Surgery Johns Creek LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ASC OF BAUCOM & MINA DERM SURGERY JOHNS CREEK LLC

Practice address

10750 Medlock Bridge Rd Ste 102
Johns Creek, GA 30097-1705

Phone

(470) 545-2124

Fax

(404) 844-0499

NPI assigned

Jun 7, 2023

Organization subpart

No

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

Authorized official

Name

Mark F Baucom, MDNPI 1831184357

Title

Owner

Phone

(404) 844-0496

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

ASC of Baucom and Mina Derm Surgery Johns Creek LLCCCN 11C0001580

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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

• Mark Francis Baucom, M.D.

  • MOHS-Micrographic Surgery Physician
  • Atlanta, GA
  • NPI 1831184357
  NPD (past) Authorized official
• Mary Alice Nading Mina, M.D.

  • MOHS-Micrographic Surgery Physician
  • Atlanta, GA
  • NPI 1538329149
  NPD (past)

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

{
    "created_epoch": "1686096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1013601517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 PEACHTREE DUNWOODY RD STE 206",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421711",
            "telephone_number": "404-844-0496",
            "fax_number": "404-844-0499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10750 MEDLOCK BRIDGE RD STE 102",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300971705",
            "telephone_number": "470-545-2124",
            "fax_number": "404-844-0499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASC OF BAUCOM & MINA DERM SURGERY JOHNS CREEK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-07",
        "last_updated": "2023-12-13",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "BAUCOM",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-844-0496",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Archway Quality Care, Inc.
• Steven T Arminio, DPM
• Jennifer A Arrieta, PA-C
• Stephen Nicholas Arroyo, PT ATC
• Valentina Afe Asamaigor, PMHNP
• Ascension Health Services
• Farooq Ashraf, M.D.
• Atlanta General and Bariatric Surgery Center, LLC
• Atlanta Hand Therapy LLC
• Atlanta Prime Physicians LLC

• Ambulatory Surgical Clinic/Center in Johns Creek, GA
• Providers in Johns Creek, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.