NPIMap

Organization Active NPI

Ear Nose Throat & Specialist-Cherokee Sinus Center

  • Specialist
  • Canton, GA
National Provider Identifier
1154445930
Registry record updated Oct 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
030684 Issued in GA
Legal business name
EAR NOSE THROAT & SPECIALIST-CHEROKEE SINUS CENTER
Practice address
215 Riverstone Dr
Canton, GA 30114-5256
Phone
(770) 345-6600
Fax
(770) 345-6611
NPI assigned
Mar 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2015

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

Authorized official

Name
Ronald Van Tuyl Jr.NPI 1447260633
Title
Physician
Phone
(770) 345-6600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 030684 GA Primary

Addresses

Primary practice location

215 Riverstone Dr
Canton, GA 30114-5256

Mailing address

215 Riverstone Dr
Canton, GA 30114-5256
Phone (770) 345-6600

Other identifiers 1

IdentifierTypeStateIssuer
000509187QMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040601000428 GA Part B Supplier - Clinic/Group Practice 9133100597 Receives reassigned benefits from 15 practitioners
Practice locations: Jasper, GA; Canton, GA; Blairsville, GA; Blue Ridge, GA

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
11D2180817Ear Nose & Throat Specialist Cherokee Sinus Center215 Riverstone Drive, Canton, GA 30114Certificate of waiverMar 19, 2028

National Provider Directory

National Provider Directory
Tax ID family
Ear Nose Throat Special2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

97 Deep South Farm Rd
Blairsville, GA 30512

215 Riverstone Dr
Canton, GA 30114
Phone (770) 281-4487

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444348800000",
    "number": "1154445930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 RIVERSTONE DR",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301145256",
            "telephone_number": "770-345-6600",
            "fax_number": "770-345-6611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 RIVERSTONE DR",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301145256",
            "telephone_number": "770-345-6600",
            "fax_number": "770-345-6611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR NOSE THROAT & SPECIALIST-CHEROKEE SINUS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2015-10-09",
        "status": "A",
        "authorized_official_last_name": "VAN TUYL",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "770-345-6600",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "030684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000509187Q",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2015; 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.