NPIMap

Individual provider Active NPI

Wayne L Ambroze, MD

  • Colon & Rectal Surgery Physician
  • Atlanta, GA
National Provider Identifier
1972561405
Registry record updated Oct 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
033019 Issued in 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
Last updated
Oct 19, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery Physician 208C00000X 033019 GA Primary

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

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gcr@cr6.gadirect.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100909000670 GA Practitioner - Colorectal Surgery (Proctology) 9234254517 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
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 LLCGroup PAC ID 8628253424, 367 clinicians

Practice addresses (Care Compare)

5445 Meridian Mark Rd
Suite 180
Atlanta, GA 30342-4755
Phone (770) 277-4277

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.18 of 100Reported as individual
Quality
73.06
Promoting interoperability
90
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy68
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
033019GAMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Surgical Professional Services LLC CurrentSince Jul 1, 2012 Accepting new patients
Northside Sepc Professional Services, LLC PastSince Sep 1, 2018 Accepting new patients
Georgia Colon & Rectall Surgical Associates PC Colon & Rectal Surgery PastSince Jul 1, 2012 Accepting new patients
NSH Cancer Institute Professional Services G LLC PastSince May 1, 2016 Accepting new patients
NSH Cancer Institute Professional Services a LLC PastSince May 1, 2016 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

  • Direct secure messaging: wambroze2281@choa.gadirect.net

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Northside Hospital ForsythCumming, GA, CCN 110005 Hospital Corporate Director May 1, 2016
Northside Hospital AtlantaAtlanta, GA, CCN 110161 Hospital Corporate Director May 1, 2016
Northside Hospital CherokeeCanton, GA, CCN 110008 Hospital Corporate Director May 1, 2016
Northside Hospital GwinnettLawrenceville, GA, CCN 110087 Hospital Corporate Director Feb 1, 2016
Northside Hospital DuluthDuluth, GA, CCN 110252 Hospital Corporate Director Feb 1, 2016
Northside Hospital IncDuluth, GA, CCN 11T252 Hospital Corporate Director Feb 1, 2016

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1972561405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5445 MERIDIAN MARKS RD",
            "address_2": "SUITE 180",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303424763",
            "telephone_number": "770-277-4277",
            "fax_number": "404-252-5745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5445 MERIDIAN MARKS RD",
            "address_2": "SUITE 180",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303424763",
            "telephone_number": "770-277-4277",
            "fax_number": "404-252-5745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBROZE",
        "first_name": "WAYNE",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "GA",
            "license": "033019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gcr@cr6.gadirect.net",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "5445 Meridian Marks Rd",
            "address_2": "Suite 180",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303424763",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.