NPIMap

Organization Active NPI

Peachtree Orthopaedic Surgery Center-North, LLC

  • Ambulatory Surgical Clinic/Center
  • Cumming, GA
National Provider Identifier
1093389421
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
PEACHTREE ORTHOPAEDIC SURGERY CENTER-NORTH, LLC
Practice address
2860 Ronald Reagan Blvd.
Ste 100
Cumming, GA 30041
Phone
(404) 425-1500
NPI assigned
May 19, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2021

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

Authorized official

Name
Tolan E. Mitchell
Title
Cfo
Phone
(404) 355-0743

Specialties & licenses 1

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

Addresses

Primary practice location

2860 Ronald Reagan Blvd.
Ste 100
Cumming, GA 30041

Mailing address

2860 Ronald Reagan Blvd.
Ste 100
Cumming, GA 30041
Phone (404) 425-1500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221004002479 GA Part B Supplier - Ambulatory Surgical Center 5395121016 Practice locations: Cumming, GA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Peachtree Orthopaedic Surgery Center North LLCCCN 11C0001551
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
11D2239381Peachtree Orthopaedic Surgery Center-North2860 Ronald Reagan Boulevard Suite 100, Cumming, GA 30041Certificate of waiverOct 11, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2860 Ronald Reagan Blvd
Ste 100
Cumming, GA 30041
Phone (404) 425-1500

Practitioners & affiliated clinicians

Practitioners 79

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

View all 79

NPI Registry JSON

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621382400000",
    "number": "1093389421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 RONALD REAGAN BLVD.",
            "address_2": "STE 100",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "30041",
            "telephone_number": "404-425-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2860 RONALD REAGAN BLVD.",
            "address_2": "STE 100",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "30041",
            "telephone_number": "404-425-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE ORTHOPAEDIC SURGERY CENTER-NORTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-19",
        "last_updated": "2021-05-19",
        "certification_date": "2021-04-27",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "TOLAN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "404-355-0743"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; 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.