Active NPI
Endoscopy Center of Middle Georgia LLC
- Ambulatory Surgical Clinic/Center
- Macon, GA
National Provider Identifier
1215915939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- License
- 011294
- Legal business name
- ENDOSCOPY CENTER OF MIDDLE GEORGIA LLC
- Practice address
- 610 Third Street
Macon, GA 31201 - Phone
- (478) 464-2600
- Fax
- (478) 738-9740
- NPI assigned
- Jan 3, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Sarah Gibbert
- Title
- Administrator
- Phone
- (478) 464-2600
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | 011294 | GA | Primary |
Addresses
Primary practice location
610 Third Street
Macon, GA 31201
Mailing address
610 Third Street
Macon, GA 31201
Phone (478) 464-2600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 720442190A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- Endsocopy Center of Middle Georgia LLC
- Medicare certification status
- Active
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D1027514 | Endoscopy Center of Middle Georgia LLC | Certificate of waiver | Jun 30, 2028 |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
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.
-
- Gastroenterology Physician
- Warner Robins, GA
- NPI 1427034818
-
- Gastroenterology Physician
- Macon, GA
- NPI 1689659260
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136246400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1407369600000",
"number": "1215915939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 THIRD STREET",
"city": "MACON",
"state": "GA",
"postal_code": "31201",
"telephone_number": "478-464-2600",
"fax_number": "478-738-9740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 THIRD STREET",
"city": "MACON",
"state": "GA",
"postal_code": "31201",
"telephone_number": "478-464-2600",
"fax_number": "478-738-9740"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ENDOSCOPY CENTER OF MIDDLE GEORGIA LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-01-03",
"last_updated": "2014-08-07",
"status": "A",
"authorized_official_last_name": "GIBBERT",
"authorized_official_first_name": "SARAH",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "478-464-2600",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": "GA",
"license": "011294",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "720442190A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; 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.