Individual provider Active NPI

Samantha Updegrove, CAA

  • Anesthesiologist Assistant
  • Gainesville, GA
National Provider Identifier
1750163341
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
11912 Issued in GA
Practice address
743 Spring St NE
Gainesville, GA 30501-3899
Phone
(770) 532-7179
NPI assigned
Oct 18, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 11912 GA Primary

Addresses

Primary practice location

743 Spring St NE
Gainesville, GA 30501-3899

Mailing address

1488 Jesse Jewell Pkwy SE Ste 201
Gainesville, GA 30501-3804
Phone (770) 532-7179

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231113001878 GA Practitioner - Anesthesiology Assistant 4587011531 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Associates of Gainesville, LLCGroup PAC ID 2769381771, 149 clinicians

Practice addresses (Care Compare)

743 Spring St NE
Gainesville, GA 30501-3715
Phone (770) 532-7179

Hospital & facility affiliations

  • Northeast Georgia Medical Center, Inc Hospital, Gainesville, GA, CCN 110029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11912GAMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Associates of Gainesville, LLC CurrentSince Oct 23, 2023 Accepting new patients
Ambulatory Anesthesia of North Georgia, LLC CurrentSince Oct 23, 2023 Accepting new patients

Locations

1400 River Pl
Braselton, GA 30517
Phone (770) 219-6000

1488 Jesse Jewell Pkwy SE
Ste 201
Gainesville, GA 30501
Phone (678) 253-0175

1240 Jesse Jewell Pkwy SE
Ste 360
Gainesville, GA 30501
Phone (770) 534-9420

743 Spring St NE
Gainesville, GA 30501
Phone (770) 219-5915

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1750163341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1488 JESSE JEWELL PKWY SE STE 201",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013804",
            "telephone_number": "770-532-7179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 SPRING ST NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013899",
            "telephone_number": "770-532-7179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UPDEGROVE",
        "first_name": "SAMANTHA",
        "credential": "CAA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-18",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "11912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.