Georgia Interventional Pain - K, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GEORGIA INTERVENTIONAL PAIN - K, LLC

Practice address

1501 Milstead Rd NE Ste 170
Conyers, GA 30012-3850

Phone

(770) 962-3642

NPI assigned

May 4, 2022

Last updated

Jan 13, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Amit Patel, MD

Title

Medical Director

Phone

(770) 962-3642

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437894276. Details of each certification follow.

• CCN 11C0001553 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 11C0001553

Legal name

Georgia Interventional Pain - K, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Oct 6, 2022

Last certification

Aug 31, 2022

Facility address

1501 Milstead Road Suite 190
Conyers, GA 30012

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

CLIA laboratory certificates

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

{
    "created_epoch": "1651622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1437894276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 PHILIP BLVD STE 140",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468768",
            "telephone_number": "770-962-3642",
            "fax_number": "770-962-3643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 MILSTEAD RD NE STE 170",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123850",
            "telephone_number": "770-962-3642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA INTERVENTIONAL PAIN - K, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-04",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "AMIT",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "770-962-3642",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Conyers, GA
• Providers in Conyers, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.