NPIMap

Organization Active NPI

The Emory Clinic Inc

Doing business as The Emory Clinic LaGrange Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Lagrange, GA
National Provider Identifier
1285912600
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
141136 Issued in GA
Legal business name
THE EMORY CLINIC INC
Doing business as
The Emory Clinic LaGrange Surgery Center
Practice address
1805 Vernon Rd
Suite C, Ambulatory Surgery Center
Lagrange, GA 30240-3871
Phone
(706) 812-9902
NPI assigned
Aug 2, 2011
Last updated
Mar 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Authorized official

Name
Mr. Donald Brunn
Title
Coo
Phone
(404) 778-5639

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 141136 GA Primary

Addresses

Primary practice location

1805 Vernon Rd
Suite C, Ambulatory Surgery Center
Lagrange, GA 30240-3871

Mailing address

1365 Clifton Rd NE
Building a, 5TH Floor Clinic Administration
Atlanta, GA 30322-1013
Phone (404) 778-5639

Other names 1

  • The Emory Clinic LaGrange Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040420000234 GA Part B Supplier - Ambulatory Surgical Center 8820901408 1 other NPI on this enrollment
Practice locations: Lagrange, GA

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Emory HealthcareCCN 11C0001390
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Emorty Clinic Inc26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Member organizations 10

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

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": "1312243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1285912600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365 CLIFTON RD NE",
            "address_2": "BUILDING A, 5TH FLOOR CLINIC ADMINISTRATION",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221013",
            "telephone_number": "404-778-5639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 VERNON RD",
            "address_2": "SUITE C, AMBULATORY SURGERY CENTER",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302403871",
            "telephone_number": "706-812-9902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EMORY CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-02",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "BRUNN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "404-778-5639",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "141136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Emory Clinic LaGrange Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Emory Clinic LaGrange Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; 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.