NPIMap

Organization Active NPI

Gainesville Foot and Ankle Surgery Center, PC

  • Ambulatory Surgical Clinic/Center
  • Gainesville, GA
National Provider Identifier
1376614826
Registry record updated Jul 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
069-279 Issued in GA
Legal business name
GAINESVILLE FOOT AND ANKLE SURGERY CENTER, PC
Practice address
1975 Beverly Rd
Suite-B
Gainesville, GA 30501-2034
Phone
(770) 536-4702
Fax
(770) 536-9394
NPI assigned
Nov 13, 2006
Last updated
Jul 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2008

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

Authorized official

Name
Wesley Lewis Daniel, D.P.M.NPI 1366513905
Title
Medical Director
Phone
(770) 536-4702

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 069-279 GA Primary

Addresses

Primary practice location

1975 Beverly Rd
Suite-B
Gainesville, GA 30501-2034

Mailing address

1975 Beverly Rd
Suite-B
Gainesville, GA 30501-2034
Phone (770) 536-4702

Other identifiers 2

IdentifierTypeStateIssuer
069-279OtherGASTATA LICENSE
51005007-002OtherGABLUE CROSS-BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090420000556 GA Part B Supplier - Clinic/Group Practice 2264589704 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gainesville, GA; Jonesboro, GA; Marietta, GA; Newnan, GA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Anesthesia Plus 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

1975B Beverly Rd
Gainesville, GA 30501
Phone (678) 902-0457

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1376614826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 BEVERLY RD",
            "address_2": "SUITE-B",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012034",
            "telephone_number": "770-536-4702",
            "fax_number": "770-536-9394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 BEVERLY RD",
            "address_2": "SUITE-B",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012034",
            "telephone_number": "770-536-4702",
            "fax_number": "770-536-9394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAINESVILLE FOOT AND ANKLE SURGERY CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2008-07-31",
        "status": "A",
        "authorized_official_last_name": "DANIEL",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_middle_name": "LEWIS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "770-536-4702",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "069-279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATA LICENSE",
            "identifier": "069-279",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS-BLUE SHIELD",
            "identifier": "51005007-002",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; 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.