NPIMap

Organization Active NPI

Avilys-Sleep & Eeg

  • Sleep Disorder Diagnostic Clinic/Center
  • Macon, GA
National Provider Identifier
1861965865
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Disorder Diagnostic Clinic/CenterTaxonomy code 261QS1200X
Legal business name
AVILYS-SLEEP & EEG
Practice address
2300 Northside Xing Ste B
Macon, GA 31210-2254
Phone
(478) 787-0059
Fax
(855) 428-4597
NPI assigned
Jan 2, 2019
Last updated
Feb 2, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

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

Authorized official

Name
Mr. Mark Shane Mobley, RRT
Title
President
Phone
(478) 787-0059

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Disorder Diagnostic Clinic/Center 261QS1200X Primary
Physiological Laboratory 293D00000X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

2300 Northside Xing Ste B
Macon, GA 31210-2254

Mailing address

2300 Northside Xing Ste B
Macon, GA 31210-2254
Phone (478) 787-0059

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220510001251 GA Part B Supplier - Clinic/Group Practice 7719303072 Receives reassigned benefits from 12 practitioners
Practice locations: Macon, GA; Warner Robins, GA

National Provider Directory

National Provider Directory

Locations

5400 Riverside Dr
Ste 101
Macon, GA 31210

100 Tommy Stalnaker Dr
#100A
Warner Robins, GA 31088

100 Tommy Stalnaker Dr
Ste 100A
Warner Robins, GA 31088
Phone (478) 787-0059

Practitioners & affiliated clinicians

Practitioners 12

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": "1546387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675296000000",
    "number": "1861965865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 NORTHSIDE XING STE B",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102254",
            "telephone_number": "478-787-0059",
            "fax_number": "855-428-4597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 NORTHSIDE XING STE B",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102254",
            "telephone_number": "478-787-0059",
            "fax_number": "855-428-4597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVILYS-SLEEP & EEG",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-02",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A",
        "authorized_official_last_name": "MOBLEY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "478-787-0059",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RRT"
    },
    "taxonomies": [
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.