NPIMap

Organization Active NPI

Interventional Spine and Pain Management Ambulatory Surgical Center

  • Ambulatory Surgical Clinic/Center
  • Conyers, GA
National Provider Identifier
1750420147
Registry record updated Feb 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
INTERVENTIONAL SPINE AND PAIN MANAGEMENT AMBULATORY SURGICAL CENTER
Practice address
1388 Wellbrook Cir NE
Suite a
Conyers, GA 30012-3872
Phone
(770) 929-9033
Fax
(770) 929-9092
NPI assigned
Feb 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2020

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

Authorized official

Name
Mrs. Victoria Beck
Title
Cfo
Phone
(404) 920-4950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X GA Primary

Addresses

Primary practice location

1388 Wellbrook Cir NE
Suite a
Conyers, GA 30012-3872

Mailing address

PO Box 11407 Dept 2344
Birmingham, AL 35246-3872
Phone (770) 929-9033

Other names 1

  • ISPM ASC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070323000138 GA Part B Supplier - Ambulatory Surgical Center 5991809469 Receives reassigned benefits from 12 practitioners
Practice locations: Conyers, GA
O20110120001157 GA Part B Supplier - Clinic/Group Practice 6406035583 Receives reassigned benefits from 110 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Roswell, GA; Marietta, GA; Lawrenceville, GA; Douglasville, GA; Dallas, GA; Covington, GA; Conyers, GA; Carrollton, GA…

Other NPIs on the same Medicare enrollment 13

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

View all 13

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Interventional Spine and Pain Management Ambulatory Surgical CenterCCN 11C0001291
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Alliance Surgery Center at Augusta7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

1367 Interstate Pkwy
Augusta, GA 30909
Phone (706) 863-3135

812 S Park St
Ste 5B
Carrollton, GA 30117

5303 Adams St NE
Ste Cd
Covington, GA 30014

3400 Chapel Hill Rd
Ste 102
Douglasville, GA 30135

Practitioners & affiliated clinicians

Practitioners 113

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

View all 113

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582934400000",
    "number": "1750420147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407 DEPT 2344",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352463872",
            "telephone_number": "770-929-9033",
            "fax_number": "770-929-9092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1388 WELLBROOK CIR NE",
            "address_2": "SUITE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123872",
            "telephone_number": "770-929-9033",
            "fax_number": "770-929-9092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL SPINE AND PAIN MANAGEMENT AMBULATORY SURGICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-02-29",
        "certification_date": "2020-02-29",
        "status": "A",
        "authorized_official_last_name": "BECK",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "404-920-4950",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ISPM ASC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "ISPM ASC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2020; 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.