Northside Foot & Ankle Outpatient Surgical Center, Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

NORTHSIDE FOOT & ANKLE OUTPATIENT SURGICAL CENTER, INC

Practice address

3415 Holcomb Bridge Road
Norcross, GA 30092-3102

Phone

(770) 580-2424

Fax

(770) 580-2425

NPI assigned

Jun 12, 2006

Last updated

Feb 25, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Portia Walker

Title

Director of Surgical Services

Phone

(770) 384-0284

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1902848286. Details of each certification follow.

• CCN 11C0001051 Ambulatory surgical center · Active · Name & address match · Details
• CCN 11C0001083 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 11C0001051

Legal name

NORTHSIDE FOOT & ANKLE OUTPAT

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jul 9, 1993

Last certification

Mar 9, 2018

Ownership / control type

Proprietary

Facility address

3415 Holcomb Bridge Road
Norcross, GA 30092

Ambulatory surgical center certification: CCN 11C0001083

Legal name

NORTHSIDE FOOT & ANKLE O P SC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Apr 10, 1996

Last certification

Mar 16, 2018

Ownership / control type

Proprietary

Facility address

466 Green Street
Gainesville, GA 30501

Practitioners 1

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.

• Robert I Schwartz, DPM

  • Podiatrist
  • Norcross, GA
  • NPI 1851354005
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551052800000",
    "number": "1902848286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 HOLCOMB BRIDGE ROAD",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300923102",
            "telephone_number": "770-580-2424",
            "fax_number": "770-580-2425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 HOLCOMB BRIDGE ROAD",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300923102",
            "telephone_number": "770-580-2424",
            "fax_number": "770-580-2425"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "466 Green St NE",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013312",
            "country_code": "US",
            "telephone_number": "770-534-3282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHSIDE FOOT & ANKLE OUTPATIENT SURGICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2019-02-25",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "PORTIA",
        "authorized_official_title_or_position": "DIRECTOR OF SURGICAL SERVICES",
        "authorized_official_telephone_number": "770-384-0284"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• North Atlanta Home Care Services LLC (FirstLight Home Care of Northeast Atlanta)
• North Atlanta Podiatry GRP,PC (d/b/a FOOT AND ANKLE CENTERS OF NE GA)
• North Pines Center Inc
• Northeast Family Practice P.C
• Northlake Obstetrics and Gynecology, PC
• Northside Maternidad
• Northview Wellness PC
• Gayle L Novitske
• Sara Elizabeth Nunning, M.A, CCC-SLP
• Roy Nzurike

• Ambulatory Surgical Clinic/Center in Norcross, GA
• Providers in Norcross, 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 Feb 25, 2019; 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.