NPIMap

Organization Active NPI

The Emory Clinic Inc

Doing business as Emory Ambulatory Surgery Center at Spivey Station

  • Ambulatory Surgical Clinic/Center
  • Jonesboro, GA
National Provider Identifier
1386165504
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
THE EMORY CLINIC INC
Doing business as
Emory Ambulatory Surgery Center at Spivey Station
Practice address
7813 Spivey Station Blvd
Jonesboro, GA 30236-2900
Phone
(404) 778-3184
NPI assigned
Jun 28, 2017
Last updated
Mar 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
EMORY CLINIC INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Authorized official

Name
Mrs. Brooke Moore
Title
Cfo
Phone
(404) 778-5014

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

7813 Spivey Station Blvd
Jonesboro, GA 30236-2900

Mailing address

2201 Henderson Mill Rd NE Ste 160
Atlanta, GA 30345-2711
Phone (404) 778-5079

Other names 1

  • EMORY AMBULATORY SURGERY CENTER AT SPIVEY STATION Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170824002755 GA Part B Supplier - Ambulatory Surgical Center 8820901408 Practice locations: Jonesboro, GA

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Emory Clinic Inc Dba Emory Ambulatory Surgery Center at Spivey StationCCN 11C0001125
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0938560Emory Ambulatory Surgery Center7813 Spivey Station Boulevard Suite 100, Jonesboro, GA 30236Certificate of waiverMay 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Emory Clinic ASC26 organizations share this tax ID, including this one
Part of
Emory Clinic ASC

Other organizations with this tax ID 25

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

View all 25

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1498608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1386165504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 HENDERSON MILL RD NE STE 160",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303452711",
            "telephone_number": "404-778-5079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7813 SPIVEY STATION BLVD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302362900",
            "telephone_number": "404-778-3184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EMORY CLINIC INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMORY CLINIC INC",
        "enumeration_date": "2017-06-28",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "404-778-5014",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EMORY AMBULATORY SURGERY CENTER AT SPIVEY STATION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jonesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.