NPIMap

Organization Active NPI

Georgia Pain Spine Center

  • Ambulatory Surgical Clinic/Center
  • Cartersville, GA
National Provider Identifier
1750494423
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
GEORGIA PAIN SPINE CENTER
Practice address
15 Medical Drive
Suite 302
Cartersville, GA 30121
Phone
(678) 337-3163
Fax
(770) 422-7306
NPI assigned
Aug 16, 2006
Last updated
Feb 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

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

Authorized official

Name
Victoria Beck
Title
Cfo
Phone
(404) 403-8310

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary
Pain Clinic/Center 261QP3300X 008-311 GA

Addresses

Primary practice location

15 Medical Drive
Suite 302
Cartersville, GA 30121

Mailing address

PO Box 11407 Dept 2657
Birmingham, AL 35246-0001
Phone (770) 920-4950

Other identifiers 1

IdentifierTypeStateIssuer
5665923OtherGACCN AND FIRST HEALTH

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051018001041 GA Part B Supplier - Ambulatory Surgical Center 8527084631 Practice locations: Cartersville, 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
Alliance Surgery Center at CartersvilleCCN 11C0001263
Medicare certification status
ActiveFrom the Provider of Services file

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
11D1040575Georgia Pain Spine Center LLC15 Medical Drive, Suite 302, Cartersville, GA 30121Certificate of waiverMay 11, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

15 Medical Dr NE
Cartersville, GA 30121
Phone (770) 386-4347

15 Medical Dr NE
Ste 302
Cartersville, GA 30121
Phone (678) 337-3163

400 Tower Rd NE
Ste 375
Marietta, GA 30060
Phone (770) 929-9093

Practitioners & affiliated clinicians

Practitioners 8

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": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582156800000",
    "number": "1750494423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407 DEPT 2657",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352460001",
            "telephone_number": "770-920-4950",
            "fax_number": "770-929-9092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 MEDICAL DRIVE",
            "address_2": "SUITE 302",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "30121",
            "telephone_number": "678-337-3163",
            "fax_number": "770-422-7306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA PAIN SPINE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "BECK",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "404-403-8310"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "GA",
            "license": "008-311",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN AND FIRST HEALTH",
            "identifier": "5665923",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cartersville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.