NPIMap

Organization Active NPI

Dekalb Gastroenterology Associates III, LLC

  • Ambulatory Surgical Clinic/Center
  • Decatur, GA
National Provider Identifier
1497895676
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
044086 Issued in GA
Legal business name
DEKALB GASTROENTEROLOGY ASSOCIATES III, LLC
Practice address
2675 N Decatur Rd
Suite 506
Decatur, GA 30033-6131
Phone
(404) 299-1679
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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

Authorized official

Name
Mark Stern, MDNPI 1407882459
Title
Medical Director
Phone
(404) 299-1679

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 044086 GA Primary

Addresses

Primary practice location

2675 N Decatur Rd
Suite 506
Decatur, GA 30033-6131

Mailing address

2675 N Decatur Rd
Suite 506
Decatur, GA 30033-6131
Phone (404) 299-1679

Other names 1

  • DEKALB ENDOSCOPY CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120220000526 GA Part B Supplier - Ambulatory Surgical Center 3375701584 Practice locations: Decatur, GA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Dekalb Endoscopy Center LLC Dba Dekalb Endoscopy CenterCCN 11C0001037
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1497895676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 N DECATUR RD",
            "address_2": "SUITE 506",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300336131",
            "telephone_number": "404-299-1679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2675 N DECATUR RD",
            "address_2": "SUITE 506",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300336131",
            "telephone_number": "404-299-1679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEKALB GASTROENTEROLOGY ASSOCIATES III, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "404-299-1679",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "044086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DEKALB ENDOSCOPY CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DEKALB ENDOSCOPY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.