SOUTHERN ENDOSCOPY SUITE, LLC
NPI 1215986609
Clinic/Center - Endoscopy in Lawrenceville, GA
NPI Status: Active since May 10, 2006
Contact Information
763 OLD NORCROSS RD
LAWRENCEVILLE, GA
ZIP 30045
Phone: (678) 985-2000
Fax: (678) 985-1999
- Organization
- Clinic/Center
- Endoscopy
- Accepts Insurance
- CLIA Number: 11D0970857
- CLIA Cert. Type: Ambulatory Surgery Center
- CLIA Exp. Date: 12-18-2026
About SOUTHERN ENDOSCOPY SUITE, LLC
This page provides the complete NPI Profile along with additional information for Southern Endoscopy Suite, Llc, a provider established in Lawrenceville, Georgia operating as a Clinic/center, focusing in endoscopy . The healthcare provider is registered in the NPI registry with number 1215986609 assigned on May 2006. The practitioner's primary taxonomy code is 261QE0800X with license number 067-200 (GA). The provider is registered as an organization and their NPI record was last updated 9 years ago. The authorized official of this NPI record is Mark B. Kukler D.o., (Owner)
- NPI
- 1215986609
- Provider Name
- SOUTHERN ENDOSCOPY SUITE, LLC
- Entity Type
- Organization
- Location Address
- 763 OLD NORCROSS RD LAWRENCEVILLE, GA 30045
- Location Phone
- (678) 985-2000
- Location Fax
- (678) 985-1999
- Mailing Address
- 763 OLD NORCROSS RD LAWRENCEVILLE, GA 30045
- Mailing Phone
- (678) 985-2000
- Mailing Fax
- (678) 985-1999
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-10-2006
- Last Update Date
- 11-28-2017
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Endoscopy
- Taxonomy Code
- 261QE0800X
- Type
- Ambulatory Health Care Facilities
- License No.
- 067-200
- License State
- GA
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Elite Bronze - HMO
- Elite Bronze + Vision + Adult Dental - HMO
- Everyday Bronze - HMO
- Everyday Bronze + Vision + Adult Dental - HMO
- Focused Silver - HMO
- Standard Expanded Bronze - HMO
- Standard Gold - HMO
- Standard Silver - HMO
- Standard Silver + Vision + Adult Dental - HMO
- Clarity Silver - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Elite Bronze - HMO
- Elite Bronze + Vision + Adult Dental - HMO
- Enhanced Diabetes Care Silver with $0 Drug Options - HMO
- Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - HMO
- Everyday Bronze - HMO
- Everyday Bronze + Vision + Adult Dental - HMO
- Everyday Gold - HMO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Clear Silver with $0 Insulin Options - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Complete Gold with Atrium Health - HMO
- Complete Gold with Atrium Health + Vision + Adult Dental - HMO
- Elite Bronze - HMO
- Elite Bronze + Vision + Adult Dental - HMO
- Elite Bronze with Atrium Health - HMO
- Elite Bronze with Atrium Health + Vision + Adult Dental - HMO
- Enhanced Asthma/COPD Care Silver with $0 Drug Options - HMO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Everyday Gold + Vision + Adult Dental - EPO
- MENDING Direct Primary Care Bronze 4950 ($0 DPC + $0 PCP + $0 Mental Health) - HMO
- MENDING Direct Primary Care Gold $0 Ded ($0 DPC $0 PCP + $0 Mental Health) - HMO
- MENDING Direct Primary Care Silver 2300 ($0 DPC + $0 PCP + $0 Mental Health) - HMO
- MENDING Standard Bronze (No Direct Primary Care, for DPC select DPC Bronze) - HMO
- MENDING Standard Gold (No Direct Primary Care, for DPC select DPC Gold) - HMO
- MENDING Standard Silver (No Direct Primary Care, for DPC select DPC Silver) - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 00888379A | MEDICARE ID-TYPE UNSPECIFIED (04) | GA |
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Balloon dilation of esophagus, stomach, and/or upper small bowel using a flexible endoscope, less than 3.0 cm
Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope
Biopsy of large bowel using a flexible endoscope
Colorectal cancer screening; colonoscopy on individual at high risk
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
Dilation of esophagus
Removal of large bowel tissue using a flexible endoscope
Removal of polyps or growths of large bowel using an endoscope with mechanical snare
This procedure involves using a flexible tube with a camera, called an endoscope, to gently expand narrowed areas in your esophagus, stomach, or upper small bowel. A small balloon is inflated, making it easier for food and liquid to pass through. It's safe and effective.
This service was performed 40 times for 40 patientsThis procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.
This service was performed 245 times for 244 patientsA biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.
This service was performed 346 times for 344 patientsColorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.
This service was performed 117 times for 117 patientsColorectal cancer screening, such as a colonoscopy, is a preventive measure to detect early signs of cancer in the large intestine. For individuals not at high risk, it's typically recommended at age 50. A small, flexible tube with a camera is used to examine your colon. It's a safe, effective way to catch issues early.
This service was performed 43 times for 43 patientsDilation of the esophagus is a procedure aimed to stretch or open up your esophagus (the tube connecting your mouth to your stomach) when it's narrow. It helps to improve swallowing and alleviate discomfort. It's typically performed using a flexible tube or balloon, under sedation.
This service was performed 13 times for 13 patientsThis procedure, known as a colonoscopy, involves using a flexible endoscope to examine and potentially remove tissue from the large intestine. The endoscope allows the doctor to view the bowel lining directly and remove any abnormal tissue for further analysis.
This service was performed 12 times for 12 patientsThis procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.
This service was performed 222 times for 219 patientsCLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 11D0970857
- Facility Type
- Ambulatory Surgery Center
- Certificate Effective Date
- December 19, 2024
- Certificate Expiration Date
- December 18, 2026
- Laboratory Director
- ARVIND KULKARNI
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Southern Endoscopy Suite, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1215986609, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 61 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
LAWRENCEVILLE, GA 30045
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1215986609, enumerated as an "organization" on May 10, 2006.
The provider is located at 763 OLD NORCROSS RD LAWRENCEVILLE, GA 30045 and the phone number is (678) 985-2000.
Clinic/Center with taxonomy code 261QE0800X and a focus in Endoscopy.
The provider might be accepting Accepts: Ambetter from Absolute Total Care, Ambetter. Please consult your insurance carrier or call the provider to verify.
