Surgicare Gwinnett

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SURGICARE GWINNETT

Practice address

367 Athens Hwy
BLD 100 Suite B
Loganville, GA 30052-2204

Phone

(678) 466-6760

NPI assigned

May 9, 2014

Last updated

May 20, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Christopher IbikunleNPI 1992981302

Title

Administrator

Phone

(678) 466-6760

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1164833398. Details of each certification follow.

• CCN 110241 Hospital · Terminated · Name & address match · Details
• CCN 11C0001558 Ambulatory surgical center · Active · Name & address match · Details

Hospital certification: CCN 110241

Legal name

SURGICARE GWINNETT LLC

Certification status

Terminated Voluntary: merger or closure, May 11, 2023

Provider type (POS)

Hospital – Short-term

Participating since

Apr 15, 2020

Last certification

Apr 15, 2020

Beds

1

Ownership / control type

Private (for profit)

Facility address

367 Athens Hwy, BLD 100 Suite B
Loganville, GA 30052

Ambulatory surgical center certification: CCN 11C0001558

Legal name

Surgicare Gwinnett

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

May 11, 2023

Last certification

May 11, 2023

Facility address

367 Athens Hwy
Loganville, GA 30052

Listed as

Surgicare GwinnettCCN 11C0001427

Medicare certification status

Terminated Voluntary: merger or closure, Apr 16, 2020From 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, and the practitioner matching its NPPES authorized official.

• Christopher Alade Ibikunle, M.D.

  • Surgery Physician
  • Loganville, GA
  • NPI 1992981302
  NPD Authorized official
• Angelina Postoev, M.D.

  • Surgery Physician
  • Loganville, GA
  • NPI 1558539155
  NPD

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

{
    "created_epoch": "1399593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400544000000",
    "number": "1164833398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 ATHENS HWY",
            "address_2": "BLD 100 SUITE B",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522204",
            "telephone_number": "678-466-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 ATHENS HWY",
            "address_2": "BLD 100 SUITE B",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522204",
            "telephone_number": "678-466-6760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICARE GWINNETT",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-09",
        "last_updated": "2014-05-20",
        "status": "A",
        "authorized_official_last_name": "IBIKUNLE",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "678-466-6760",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Hope Stewart, MS
• Amanda Kleweno Stewart, PT
• Lashauna Stewart
• Stillwell Medical Group
• Joann Yamile Stvil, RN
• Surgicare Plus LLC
• Sweet Peach Blossom, a Mindfulness Practice
• Thenethong Sybangone, CNA
• Hasan Ali Syed, D.M.D.
• Saima Syed, MD

• Ambulatory Surgical Clinic/Center in Loganville, GA
• Providers in Loganville, 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 May 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.