Ga Pain Management Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GA PAIN MANAGEMENT CENTER, LLC

Practice address

165 N Park TRL
Suite 100
Stockbridge, GA 30281-6500

Phone

(770) 506-1800

Fax

(770) 389-4461

NPI assigned

Mar 15, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Randall Berinhout, M.D.

Title

Medical Director

Phone

(770) 506-1800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 11C0001422

Legal name

GEORGIA PAIN MANAGEMENT CENTER, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Sep 26, 2014

Last certification

Sep 26, 2014

Ownership / control type

Proprietary

Facility address

165 North Park Trail
Stockbridge, GA 30281

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

{
    "created_epoch": "1268611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398124800000",
    "number": "1801110275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 N PARK TRL",
            "address_2": "SUITE 100",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816500",
            "telephone_number": "770-506-1800",
            "fax_number": "770-389-4461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 N PARK TRL",
            "address_2": "SUITE 100",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816500",
            "telephone_number": "770-506-1800",
            "fax_number": "770-389-4461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GA PAIN MANAGEMENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-15",
        "last_updated": "2014-04-22",
        "status": "A",
        "authorized_official_last_name": "BERINHOUT",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "770-506-1800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawnniwia Frye
• Terri George Furlow
• Fusion Direct Medical and Wellness
• Fusion Direct Medical and Wellness
• Fusion Health and Wellness Corp
• Funlola M Gaddis, NP-C
• Vincent Galan, MD
• Mayra Janet Galvan
• Sebastian Andres Gandarillas Fraga, M.D
• Carlos Tomas Garcia, PHARM.D.

• Ambulatory Surgical Clinic/Center in Stockbridge, GA
• Providers in Stockbridge, 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 Apr 22, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.