NPIMap

Organization Active NPI

Southern Anesthesia of Augusta LLC

  • Certified Registered Nurse Anesthetist
  • Augusta, GA
National Provider Identifier
1356706709
Registry record updated Dec 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
SOUTHERN ANESTHESIA OF AUGUSTA LLC
Practice address
905 Stevens Creek Rd
Augusta, GA 30907-3201
Phone
(706) 922-6000
Fax
(706) 722-7994
NPI assigned
Dec 29, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2015

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

Authorized official

Name
Jason FaunceNPI 1750612057
Title
MBR
Phone
(706) 533-4612

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

905 Stevens Creek Rd
Augusta, GA 30907-3201

Mailing address

PO Box 16579
Augusta, GA 30919-2579
Phone (706) 868-0131

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160225001532 GA Part B Supplier - Clinic/Group Practice 5294030466 Receives reassigned benefits from 20 practitioners
Practice locations: Waynesboro, GA; Washington, GA; Brunswick, GA; Augusta, GA
O20220504001730 SC Part B Supplier - Clinic/Group Practice 5294030466 Receives reassigned benefits from 6 practitioners
Practice locations: Aiken, SC; Lexington, SC

National Provider Directory

National Provider Directory
Tax ID family
Southern Anesthesia of Augusta LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1215 W Wheeler Pkwy
Augusta, GA 30909
Phone (706) 564-4807

3685 Wheeler Rd
Ste 202
Augusta, GA 30909
Phone (423) 892-9483

4711 Sunset Blvd
Lexington, SC 29072
Phone (803) 356-3609

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1451347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451347200000",
    "number": "1356706709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16579",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309192579",
            "telephone_number": "706-868-0131",
            "fax_number": "706-854-0131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 STEVENS CREEK RD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309073201",
            "telephone_number": "706-922-6000",
            "fax_number": "706-722-7994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ANESTHESIA OF AUGUSTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-29",
        "last_updated": "2015-12-29",
        "status": "A",
        "authorized_official_last_name": "FAUNCE",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "MBR",
        "authorized_official_telephone_number": "706-533-4612"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.