NPIMap

Organization Active NPI

Spectrum Anesthesia, LLC

  • Certified Registered Nurse Anesthetist
  • Atlanta, GA
National Provider Identifier
1578074993
Registry record updated Oct 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN219398 Issued in GA
Legal business name
SPECTRUM ANESTHESIA, LLC
Practice address
67 Peachtree Park Dr NE Ste 101
Atlanta, GA 30309-1318
Phone
(573) 579-9048
NPI assigned
Oct 12, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2017

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

Authorized official

Name
Mr. Michael MercerNPI 1326319286
Title
Owner
Phone
(573) 579-9048

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
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X RN219398 GA Primary

Addresses

Primary practice location

67 Peachtree Park Dr NE Ste 101
Atlanta, GA 30309-1318

Mailing address

1639 Bradley Park Dr Ste 500
Columbus, GA 31904-3623
Phone (573) 579-9048

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180607001073 GA Part B Supplier - Clinic/Group Practice 8921363268 Receives reassigned benefits from 10 practitioners
Practice locations: Newnan, GA; Lagrange, GA; Fayetteville, GA; Columbus, GA; Atlanta, GA; Carrollton, GA

National Provider Directory

National Provider Directory

Locations

158 Clinic Ave
#B
Carrollton, GA 30117
Phone (770) 834-1001

7351 Old Moon Rd
Columbus, GA 31909
Phone (706) 221-2721

1015 Lafayette Pkwy
Ste 100
Lagrange, GA 30241
Phone (762) 842-0221

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1507766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507766400000",
    "number": "1578074993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1639 BRADLEY PARK DR STE 500",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319043623",
            "telephone_number": "573-579-9048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 PEACHTREE PARK DR NE STE 101",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091318",
            "telephone_number": "573-579-9048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM ANESTHESIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-12",
        "last_updated": "2017-10-12",
        "status": "A",
        "authorized_official_last_name": "MERCER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-579-9048",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN219398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2017; 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.