NPIMap

Organization Active NPI

Endoscopy Center of Coastal Georgia, LLC

  • Ambulatory Surgical Clinic/Center
  • Savannah, GA
National Provider Identifier
1821106923
Registry record updated Mar 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
86172S Issued in GA
Legal business name
ENDOSCOPY CENTER OF COASTAL GEORGIA, LLC
Practice address
519 Stephenson Ave
Savannah, GA 31405-5969
Phone
(912) 354-9447
Fax
(912) 303-9246
NPI assigned
Aug 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2009

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

Authorized official

Name
Mrs. Judy L Gilliam
Title
Billing Manager
Phone
(912) 354-9447

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 86172S GA Primary

Addresses

Primary practice location

519 Stephenson Ave
Savannah, GA 31405-5969

Mailing address

519 Stephenson Ave
Savannah, GA 31405-5969
Phone (912) 354-9447

Other identifiers 1

IdentifierTypeStateIssuer
000969702AMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040526000258 GA Part B Supplier - Ambulatory Surgical Center 4082695044 Receives reassigned benefits from 6 practitioners
Practice locations: Savannah, GA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Endoscopy Center of Coastal Georgia LLCCCN 11C0001200
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
11D0996849Endoscopy Center of Coastal Georgia519 Stephenson Avenue, Savannah, GA 31405Certificate of waiverFeb 28, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236556800000",
    "number": "1821106923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 STEPHENSON AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314055969",
            "telephone_number": "912-354-9447",
            "fax_number": "912-303-9246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 STEPHENSON AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314055969",
            "telephone_number": "912-354-9447",
            "fax_number": "912-303-9246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDOSCOPY CENTER OF COASTAL GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2009-03-09",
        "status": "A",
        "authorized_official_last_name": "GILLIAM",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "912-354-9447",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "86172S",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000969702A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; 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.