NPIMap

Organization Active NPI

Medside Corporation

Doing business as MedSide Healthcare

  • Home Health Agency
  • Sandy Springs, GA
National Provider Identifier
1306858121
Registry record updated Nov 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
060-245-H Issued in GA
Legal business name
MEDSIDE CORPORATION
Doing business as
MedSide Healthcare
Practice address
1120 Hope Road
Sandy Springs, GA 30350
Phone
(404) 633-7433
Fax
(888) 633-7430
NPI assigned
Aug 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2020

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

Authorized official

Name
Dr. Viktor Vaysman, MD
Title
Ceo
Phone
(404) 633-7433

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 060-245-H GA Primary
Home Health Agency 251E00000X 060-R-0068 GA
In Home Supportive Care Agency 253Z00000X 060-R-0068 GA

Addresses

Primary practice location

1120 Hope Road
Sandy Springs, GA 30350

Mailing address

1120 Hope Rd # 310
Sandy Springs, GA 30350-2957
Phone (404) 633-7433

Other identifiers 6

IdentifierTypeStateIssuer
003231615AMedicaidGA
00869943DMedicaidGA
00869943BMedicaidGA
00869943AMedicaidGA
00849527AMedicaidGA
00869943CMedicaidGA

Other names 1

  • MedSide Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090521000397 GA Part A Provider - Home Health Agency 5294884276 Practice locations: Sandy Spring, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306858121. Details of each certification follow.

Home health agency certification: CCN 117126

Legal name
MEDSIDE CORPORATION
Doing business as
MEDSIDE HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 30, 1999
Last certification
Jan 10, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Dec 23, 1999 in GA
Enrollment address
1120 Hope Road
Sandy Spring, GA 30350-2957

Care Compare: Home health agency

Medicare Care Compare
Listed as
Medside Home Health AgencyCCN 117126 · All quality measures
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Jul 30, 1999
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

1120 Hope Rd
Sandy Springs, GA 30350
Phone (404) 633-7433

1120 Hope Rd
#310
Sandy Springs, GA 30350

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Victor Vaysman Individual 5% Or Greater Direct Ownership Interest Jan 1, 2009
Operational/Managerial Control Jan 1, 2009

Practitioners & affiliated clinicians

Affiliated clinicians 8

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605744000000",
    "number": "1306858121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 HOPE RD # 310",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303502957",
            "telephone_number": "404-633-7433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 HOPE ROAD",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "30350",
            "telephone_number": "404-633-7433",
            "fax_number": "888-633-7430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSIDE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A",
        "authorized_official_last_name": "VAYSMAN",
        "authorized_official_first_name": "VIKTOR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-633-7433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "GA",
            "license": "060-245-H",
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "GA",
            "license": "060-R-0068",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "GA",
            "license": "060-R-0068",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003231615A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00869943D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00869943B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00869943A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00849527A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00869943C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedSide Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MedSide Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandy Springs, GA

Sources for this page

Verify at the official NPI Registry.