Wayne L Ambroze, MD
Individual provider Active NPI Colon & Rectal Surgery Physician · Atlanta, GA
NPI 1972561405 · NPPES record last updated Oct 19, 2020
Key facts
- NPI
- 1972561405
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Colon & Rectal Surgery Physician 208C00000X
- License
- 033019 (GA)
- Practice address
- 5445 Meridian Marks Rd
Suite 180
Atlanta, GA 30342-4763 - Phone
- (770) 277-4277
- Fax
- (404) 252-5745
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 2
Owned or controlled facilities with NPI records 6
Medicare Care Compare profile
- Specialty
- Colorectal Surgery (Proctology)
- Education
- Northwestern University Feinberg Medical School, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northside Surgical Professional Services LLC
Practice addresses (Care Compare)
5445 Meridian Mark Rd
Suite 180
Atlanta, GA 30342-4755
Phone (770) 277-4277
Hospital & facility affiliations
- Northside Hospital
- Northside Hospital Forsyth
Merit-based Incentive Payment System (MIPS)
- Final score
- 82.18 of 100
- Quality
- 73.06
- Promoting interoperability
- 90
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 68 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| Northside Hospital Forsyth |
Hospital | Corporate Director | May 1, 2016 |
| Northside Hospital Atlanta |
Hospital | Corporate Director | May 1, 2016 |
| Northside Hospital Cherokee |
Hospital | Corporate Director | May 1, 2016 |
| Northside Hospital Gwinnett |
Hospital | Corporate Director | Feb 1, 2016 |
| Northside Hospital Duluth |
Hospital | Corporate Director | Feb 1, 2016 |
| Northside Hospital Inc |
Hospital | Corporate Director | Feb 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100909000670 | GA | Practitioner - Colorectal Surgery (Proctology) | 9234254517 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033019 | GA | MD | Colon & Rectal Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northside Surgical Professional Services LLC | Current |
Accepting new patients | |
| Georgia Colon & Rectall Surgical Associates PC | Colon & Rectal Surgery | Past |
Accepting new patients |
| NSH Cancer Institute Professional Services G LLC | Past |
Accepting new patients | |
| NSH Cancer Institute Professional Services a LLC | Past |
Accepting new patients | |
| Northside Sepc Professional Services, LLC | Past |
Accepting new patients |
Locations
3400 Old Milton Pkwy
Ste A440
Alpharetta, GA 30005
Phone (404) 459-1900
1505 Northside Blvd
Ste 2900
Cumming, GA 30041
2675 N Decatur Rd
Ste 307
Decatur, GA 30033
Phone (404) 292-0393
1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737
1000 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 851-1000
5445 Meridian Mark Rd
Ste 180
Sandy Springs, GA 30342
5555 Peachtree Dunwoody Rd
Ste 206
Sandy Springs, GA 30342
Phone (404) 292-0393
Interoperability endpoints
- wambroze2281@choa.gadirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Colon & Rectal Surgery Physician | 208C00000X | 033019 | GA | Yes |
Addresses
Primary practice location
5445 Meridian Marks Rd
Suite 180
Atlanta, GA 30342-4763
Mailing address
5445 Meridian Marks Rd
Suite 180
Atlanta, GA 30342-4763
Phone (770) 277-4277
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52022684 | Other | BCBS | |
| 1406030 | Other | UNITED HEALTHCAREE | |
| 216188012 | Other | CIGNA HMO | |
| 4120130 | Other | AETNA NON HMO | |
| 1129 | Other | KAISER | |
| 519446 | Other | AETNA HMO | |
| 00432011B | Medicaid | GA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | gcr@cr6.gadirect.net | Direct |
Other providers in Atlanta, GA
- Amber Peach LLC
- Ambitious Compassion Wellness Counseling
- Anthony Robert Ambrose
- John Hutchings Ambrose Jr.
- Stephanie Ambrose
- Ambulatory Anesthesia Alliance of Ga LLC
- Ambulatory Anesthesia Associates, LLC
- Ambulatory Anesthesia Partners LLC
- AMC Enterprises (MN) Inc
- AMC Neurosurgical Asociates, LLC
All providers in Atlanta, GA · Colon & Rectal Surgery Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.