NPIMap

Organization Active NPI

Avvsc Lawrenceville, LLC

  • Ambulatory Surgical Clinic/Center
  • Lawrenceville, GA
National Provider Identifier
1427435007
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
AVVSC LAWRENCEVILLE, LLC
Practice address
600 Professional Dr
Suite 160B
Lawrenceville, GA 30046-7651
Phone
(678) 878-4555
Fax
(678) 878-4556
NPI assigned
May 2, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

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

Authorized official

Name
Amish Tilara, M.D.NPI 1912221359
Title
President
Phone
(678) 878-4555

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X
Ambulatory Surgical Clinic/Center 261QA1903X Primary
Medical Specialty Clinic/Center 261QM2500X
Radiology Clinic/Center 261QR0200X

Addresses

Primary practice location

600 Professional Dr
Suite 160B
Lawrenceville, GA 30046-7651

Mailing address

600 Professional Dr.
Suite 160 B
Lawrenceville, GA 30046-8717

Other identifiers 1

IdentifierTypeStateIssuer
11C0001456MedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170117001048 GA Part B Supplier - Ambulatory Surgical Center 5890077440 Practice locations: Lawrenceville, GA

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
11D2108805Avvsc Lawrenceville600 Professional Drive, Lawrenceville, GA 30046Certificate of waiverFeb 11, 2028

National Provider Directory

National Provider Directory

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": "1430524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688083200000",
    "number": "1427435007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 PROFESSIONAL DR.",
            "address_2": "SUITE 160 B",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PROFESSIONAL DR",
            "address_2": "SUITE 160B",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300467651",
            "telephone_number": "678-878-4555",
            "fax_number": "678-878-4556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVVSC LAWRENCEVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-02",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "TILARA",
        "authorized_official_first_name": "AMISH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-878-4555",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11C0001456",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.