NPIMap

Organization Active NPI

Surgery Clinic, LLC

  • Surgery Physician
  • Gadsden, AL
National Provider Identifier
1205893732
Registry record updated Aug 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SURGERY CLINIC, LLC
Practice address
419 S 5TH St
Gadsden, AL 35901-5101
Phone
(256) 547-6331
Fax
(256) 547-1711
NPI assigned
Apr 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2011

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

Authorized official

Name
Dianette Keener
Title
Billing Manager
Phone
(256) 547-6331

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X AL Primary
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X AL

Addresses

Primary practice location

419 S 5TH St
Gadsden, AL 35901-5101

Mailing address

419 S 5TH St
Gadsden, AL 35901-5101
Phone (256) 547-6331

Other identifiers 1

IdentifierTypeStateIssuer
528202650MedicaidAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110303000651 AL Part B Supplier - Clinic/Group Practice 8426230095 Receives reassigned benefits from 3 practitioners
3 other NPIs on this enrollment
Practice locations: Gadsden, AL; Jacksonville, AL

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313539200000",
    "number": "1205893732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 S 5TH ST",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359015101",
            "telephone_number": "256-547-6331",
            "fax_number": "256-547-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 S 5TH ST",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359015101",
            "telephone_number": "256-547-6331",
            "fax_number": "256-547-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2011-08-17",
        "status": "A",
        "authorized_official_last_name": "KEENER",
        "authorized_official_first_name": "DIANETTE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "256-547-6331"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "AL",
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "AL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528202650",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gadsden, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.