Southeast Eye Laser Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SOUTHEAST EYE LASER SURGERY CENTER

Practice address

3215 Shrine Rd Ste 8
Brunswick, GA 31520-4300

Phone

(706) 296-7932

Fax

(912) 574-5824

NPI assigned

Sep 29, 2021

Last updated

Sep 29, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sandra Jordan Nemetz, RN

Title

Surgery Center Director

Phone

(706) 296-7932

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346912250. Details of each certification follow.

• CCN 11C0001546 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 11C0001546

Legal name

Southeast Eye Laser Surgery Center, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Aug 30, 2022

Last certification

Aug 12, 2022

Facility address

3215 Shrine Road Building 8
Brunswick, GA 31520

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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.

• John Edwin Imhoff, MD

  • Ophthalmology Physician
  • Brunswick, GA
  • NPI 1669480513
  NPD (past)

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

{
    "created_epoch": "1632873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632873600000",
    "number": "1346912250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3215 SHRINE RD STE 8",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204300",
            "telephone_number": "706-296-7932",
            "fax_number": "912-574-5824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3215 SHRINE RD STE 8",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204300",
            "telephone_number": "706-296-7932",
            "fax_number": "912-574-5824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST EYE LASER SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-29",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A",
        "authorized_official_last_name": "NEMETZ",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "JORDAN",
        "authorized_official_title_or_position": "SURGERY CENTER DIRECTOR",
        "authorized_official_telephone_number": "706-296-7932",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "SurgeryCenter",
            "affiliation": "N",
            "endpointDescription": "Surgerydata",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3215 Shrine Rd Ste 8",
            "city": "Brunswick",
            "state": "GA",
            "country_code": "US",
            "postal_code": "315204300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• South Georgia Psychological Services PC
• South Port Dentistry
• Southeast Georgia Health System, Inc. (Southeast Georgia Health System - Brunswick Campus)
• Southeast Georgia Health System, Inc.
• Southeast Georgia Hematology/Oncology Assoc.
• Southeast Georgia Open MRI LLC
• Southeast Georgia Urology Associates PC

• Ambulatory Surgical Clinic/Center in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.