Organization Active NPI

Cornerstone General Surgery Clinic Inc

  • Surgery Physician
  • Guntersville, AL
National Provider Identifier
1366870362
Registry record updated May 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
26404 Issued in AL
Legal business name
CORNERSTONE GENERAL SURGERY CLINIC INC
Practice address
1939 Patterson St Ste 102
Guntersville, AL 35976-2017
Phone
(225) 930-0060
Fax
(225) 952-9075
NPI assigned
Oct 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2014

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

Authorized official

Name
Mr. Keith Monk
Title
President
Phone
(225) 930-0060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 26404 AL Primary

Addresses

Primary practice location

1939 Patterson St Ste 102
Guntersville, AL 35976-2017

Mailing address

PO Box 14149
Baton Rouge, LA 70898-4149
Phone (225) 930-0060

Other identifiers 1

IdentifierTypeStateIssuer
154531MedicaidAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131216000581 AL Part B Supplier - Clinic/Group Practice 3678700804 Receives reassigned benefits from 2 practitioners
Practice locations: Guntersville, AL

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.

NPI Registry JSON

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

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400457600000",
    "number": "1366870362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14149",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708984149",
            "telephone_number": "225-930-0060",
            "fax_number": "225-952-9075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1939 PATTERSON ST STE 102",
            "city": "GUNTERSVILLE",
            "state": "AL",
            "postal_code": "359762017",
            "telephone_number": "225-930-0060",
            "fax_number": "225-952-9075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE GENERAL SURGERY CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-29",
        "last_updated": "2014-05-19",
        "status": "A",
        "authorized_official_last_name": "MONK",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "225-930-0060",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "AL",
            "license": "26404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154531",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Guntersville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; 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.