NPIMap

Organization Active NPI

Marietta Eye Clinic, PA

  • Ophthalmology Physician
  • Cumming, GA
National Provider Identifier
1629784160
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MARIETTA EYE CLINIC, PA
Practice address
2860 Ronald Reagan Blvd Ste 210
Cumming, GA 30041-6092
Phone
(770) 427-8111
NPI assigned
Jan 27, 2023
Last updated
Mar 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MARIETTA EYE CLINIC, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Authorized official

Name
Henry Elliott Gatehouse
Title
Director
Phone
(770) 427-8111

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

2860 Ronald Reagan Blvd Ste 210
Cumming, GA 30041-6092

Mailing address

895 Canton Rd NE
Marietta, GA 30060-8934
Phone (770) 427-8111

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040518000057 GA Part B Supplier - Clinic/Group Practice 0143210427 Receives reassigned benefits from 46 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Woodstock, GA; Villa Rica, GA; Suwanee, GA; Roswell, GA; Marietta, GA; Acworth, GA; Canton, GA; Cartersville, GA…

Other NPIs on the same Medicare enrollment 14

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

View all 14

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
11D2283729Marietta Eye Clinic, PA2860 Ronald Reagan Boulevard, Suite 210, Cumming, GA 30041Certificate of waiverJun 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
Marietta Eye Clinic PA17 organizations share this tax ID, including this one
Part of
Marietta Eye Clinic PA

Other organizations with this tax ID 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 6

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": "1674777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678320000000",
    "number": "1629784160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "895 CANTON RD NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608934",
            "telephone_number": "770-427-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2860 RONALD REAGAN BLVD STE 210",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300416092",
            "telephone_number": "770-427-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA EYE CLINIC, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARIETTA EYE CLINIC, PA",
        "enumeration_date": "2023-01-27",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "GATEHOUSE",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "ELLIOTT",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "770-427-8111"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

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