Georgia Interventional Pain - F, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GEORGIA INTERVENTIONAL PAIN - F, LLC

Practice address

1357 Hembree Rd Ste 230
Roswell, GA 30076-5725

Phone

(770) 962-3642

Fax

(770) 962-3643

NPI assigned

Dec 13, 2019

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

Amit Patel, MDNPI 1386834117

Title

Chief Executive Officer

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 1700424322. Details of each certification follow.

• CCN 11C0001525 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 11C0001525

Legal name

GEORGIA INTERVENTIONAL PAIN F, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Nov 9, 2020

Last certification

Jul 31, 2020

Ownership / control type

Proprietary

Facility address

1357 Hembree Rd, Ste 230
Roswell, GA 30076

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

CLIA laboratory certificates

Locations

Practitioners 2

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.

• Amit Patel, MD

  • Anesthesiology Physician
  • Lawrenceville, GA
  • NPI 1386834117
  NPD (past) Authorized official
• Gabriel Marrero, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Lawrenceville, GA
  • NPI 1871789214
  NPD (past)

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

{
    "created_epoch": "1576195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1700424322",
    "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": "1357 HEMBREE RD STE 230",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765725",
            "telephone_number": "770-962-3642",
            "fax_number": "770-962-3643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA INTERVENTIONAL PAIN - F, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-13",
        "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": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "770-962-3642",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "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": []
}

• Georgia CVS Pharmacy, L.L.C. (CVS Pharmacy #02227)
• Georgia CVS Pharmacy, L.L.C. (CVS Pharmacy #02178)
• Georgia Developmental Services (Children's Therapy Works)
• Georgia Gifts From Grace LLC (Georgia Gifts from Grace)
• Georgia Health Clinics, LLC
• Georgia Neck & Spine Center LLC
• Georgia North Fulton Healthcare Associates, LLC (North Fulton Healthcare Associates)
• Georgia Northside Ear, Nose and Throat, LLC
• Georgia Ophthalmology Referral Center, LLC (Woolfson Eye Institute, LLC)
• Georgia Pain and Wellness Center (Summit Spine & Joint Centers)

• Ambulatory Surgical Clinic/Center in Roswell, GA
• Providers in Roswell, 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.