NPIMap

Organization Active NPI

Sleep Disorder Center @ Gwinnett Clinic

Doing business as Gwinnett Clinic

  • Legal Medicine
  • Suwanee, GA
National Provider Identifier
1619242302
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
Legal business name
SLEEP DISORDER CENTER @ GWINNETT CLINIC
Doing business as
Gwinnett Clinic
Practice address
2650 Lawrenceville Suwanee Rd
Ste B
Suwanee, GA 30024-2535
Phone
(678) 205-5000
Fax
(678) 240-2080
NPI assigned
Mar 14, 2012
Last updated
Jul 12, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
GWINNETT CLINIC, LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

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

Authorized official

Name
Dr. Jayendrakumar J Shah, MDNPI 1568411254
Title
President
Phone
(770) 995-3300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Disorder Diagnostic Clinic/Center 261QS1200X
Legal Medicine 173000000X Primary

Addresses

Primary practice location

2650 Lawrenceville Suwanee Rd
Ste B
Suwanee, GA 30024-2535

Mailing address

475 Philip Blvd
Ste 100
Lawrenceville, GA 30046-8737
Phone (770) 995-3300

Other names 1

  • GWINNETT CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031104000266 GA Part B Supplier - Clinic/Group Practice 9436061801 Receives reassigned benefits from 47 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lilburn, GA; Logan, GA; Lawrenceville, GA; Monroe, GA; Norcross, GA; Snellville, GA; Suwanee, GA; Tucker, GA…

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

National Provider Directory

National Provider Directory
Tax ID family
Gwinnett Clinic LTD7 organizations share this tax ID, including this one
Part of
Gwinnett Clinic LTD

Other organizations with this tax ID 6

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

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/32352/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 4

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": "1331683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626048000000",
    "number": "1619242302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 PHILIP BLVD",
            "address_2": "STE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468737",
            "telephone_number": "770-995-3300",
            "fax_number": "770-995-3307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 LAWRENCEVILLE SUWANEE RD",
            "address_2": "STE B",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242535",
            "telephone_number": "678-205-5000",
            "fax_number": "678-240-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SLEEP DISORDER CENTER @ GWINNETT CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GWINNETT CLINIC, LTD",
        "enumeration_date": "2012-03-14",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "JAYENDRAKUMAR",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-995-3300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GWINNETT CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GWINNETT CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Suwanee, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; 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.