Organization Active NPI

Endoscopy Center of Middle Georgia LLC

  • Ambulatory Surgical Clinic/Center
  • Macon, GA
National Provider Identifier
1215915939
Registry record updated Aug 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
011294 Issued in GA
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

Updated by the provider on Aug 7, 2014

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
720442190AMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041018000639 GA Part B Supplier - Ambulatory Surgical Center 8921068578 Receives reassigned benefits from 1 practitioner
Practice locations: Macon, GA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Endsocopy Center of Middle Georgia LLCCCN 11C0001245
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
11D1027514Endoscopy Center of Middle Georgia LLC610 Third Street, Macon, GA 31201Certificate of waiverJun 30, 2028

National Provider Directory

National Provider Directory

Practitioners & 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.

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.

Verify at the official NPI Registry.