NPIMap

Organization Active NPI

Augusta Plastic Surgery Center, Inc.

  • Ambulatory Surgical Clinic/Center
  • Martinez, GA
National Provider Identifier
1013990308
Registry record updated Jul 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
121-114 Issued in GA
Legal business name
AUGUSTA PLASTIC SURGERY CENTER, INC.
Practice address
569 Furys Ferry Rd
Martinez, GA 30907-9059
Phone
(706) 724-5611
Fax
(706) 724-5435
NPI assigned
Nov 21, 2005
Last updated
Jul 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2020

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

Authorized official

Name
Charon P Bartley
Title
Billing Manager
Phone
(706) 724-5611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 121-114 GA Primary

Addresses

Primary practice location

569 Furys Ferry Rd
Martinez, GA 30907-9059

Mailing address

569 Furys Ferry Rd
Martinez, GA 30907-9059
Phone (706) 724-5611

Other identifiers 2

IdentifierTypeStateIssuer
ASC009MedicaidSC
000728472AMedicaidGA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Augusta Plastic Surgery Center IncCCN 11C0001090
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2004718Augusta Plastic Surgery Center, Inc569 Furys Ferry Road, Martinez, GA 30907Certificate of waiverMar 10, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595376000000",
    "number": "1013990308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "569 FURYS FERRY RD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309079059",
            "telephone_number": "706-724-5611",
            "fax_number": "706-724-5435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "569 FURYS FERRY RD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309079059",
            "telephone_number": "706-724-5611",
            "fax_number": "706-724-5435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTA PLASTIC SURGERY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-21",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A",
        "authorized_official_last_name": "BARTLEY",
        "authorized_official_first_name": "CHARON",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "706-724-5611"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "121-114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ASC009",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000728472A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinez, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.