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SPORTS MEDICINE SOUTH OF GWINNETT LLC
NPI 1265053110
Orthopaedic Surgery - Sports Medicine in Lawrenceville, GA

Active since May 01, 2020CLIA 11D1085597 · Waiver
1900 RIVERSIDE PKWY, LAWRENCEVILLE, GA 30043(770) 237-3475 Get Directions Write a Review

NPPES record last updated: May 18, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 18, 2026, Jun 3, 2025, Aug 12, 2021 and 1 more (4 updates tracked since 2020).

About Sports Medicine South Of Gwinnett Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SPORTS MEDICINE SOUTH OF GWINNETT LLC (NPI 1265053110) is a healthcare organization registered as a sports medicine in Lawrenceville, Georgia and active in the NPI registry since May 2020. The organization holds a CLIA Waiver certificate valid through June 22, 2028 and lists Amy E Fouts, Chief Compliance Officer, as its authorized official.

NPPES Registry Identity

NPI1265053110
Entity TypeOrganization
Primary Taxonomy207XX0005X
Legal Business NameSPORTS MEDICINE SOUTH OF GWINNETT LLC
Location Address1900 RIVERSIDE PKWYLawrenceville, GA 30043-5925
Mailing Address1001 Summit Blvd Ste 1000Brookhaven, GA 30319-6415 · (404) 851-8000
Phone(770) 237-3475
Organization SubpartNo
Authorized OfficialAmy E FoutsChief Compliance Officer · (404) 851-6968
Enumeration DateMay 1, 2020
Last NPPES UpdateMay 18, 20264 updates tracked since enumeration
NPPES CertifiedMay 18, 2026
✔ NPI 1265053110 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic Surgery · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207XX0005X
Definition
An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries.
1900 RIVERSIDE PKWY, Lawrenceville, GA 30043
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sports Medicine South Of Gwinnett Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

9

Medicare enrollment records show 9 clinicians reassign Medicare billing to Sports Medicine South Of Gwinnett LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (9)

Harrison Goodno, MD
Sports Medicine
NPI 1942512959
1900 RIVERSIDE PKWY
Lawrenceville, GA 30043
(770) 237-3475
✔ PECOS✔ Accepts MedicareSame address
Gary Levengood, M.D.
Orthopedic Surgery
NPI 1871593285
1900 RIVERSIDE PKWY
Lawrenceville, GA 30043
(770) 237-3475
✔ PECOS✔ Accepts MedicareSame address
Elan Golan, M.D.
Orthopedic Surgery
NPI 1306102785
2220 WISTERIA DR STE 202
Snellville, GA 30078
(678) 344-4944
✔ PECOS✔ Accepts Medicare7.7 mi
Jaeson Courseault
Family Practice
NPI 1609137140
3939 LAVISTA RD STE. E274
Atlanta, GA 30345
(404) 500-7224
✔ PECOS✔ Accepts Medicare17 mi
Roland Webster, DPT
Physical Therapist in Private Practice
NPI 1881147411
3122 HIGHWAY 278 NW
Covington, GA 30014
(470) 444-1609
✔ Accepts Medicare27 mi
Donald Walsh, PT, MS, OCS
Physical Therapist in Private Practice
NPI 1881883619
159 SUNSET DR STE 102
Dahlonega, GA 30597
(706) 482-2268
✔ Accepts Medicare38 mi
Sean Macko
Physical Therapist in Private Practice
NPI 1811470545
80 SEVEN HILLS BLVD STE 107
Dallas, GA 30132
(678) 402-0515
✔ Accepts Medicare43 mi
Michael Polascik, PT ATC
Physical Therapist in Private Practice
NPI 1609899558
3708 NORTHSIDE DR
Macon, GA 31210
(478) 745-4206
77 mi
Clay Guynn, D.O.
Physical Medicine and Rehabilitation
NPI 1699180398
800 ROSE ST
Lexington, KY 40536
(859) 257-1000
✔ PECOS✔ Accepts Medicare281 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D1085597

Sports Medicine South LLC · Lawrenceville, GA
Active · expires Jun 22, 2028
CLIA Number11D1085597
Laboratory TypePhysician Office
Certificate Effective DateJune 23, 2026
Certificate Expiration DateJune 22, 2028
Laboratory DirectorGary A. Levengood MD
Laboratory Phone(770) 237-3475
Laboratory LocationSports Medicine South LLC1900 Riverside Parkway, Lawrenceville, GA 30043
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sports Medicine South Of Gwinnett LLC's NPI number?

The NPI number for Sports Medicine South Of Gwinnett LLC is 1265053110. It was assigned to this organization in the NPPES registry on May 1, 2020.

Where is Sports Medicine South Of Gwinnett LLC located?

Sports Medicine South Of Gwinnett LLC is located at 1900 Riverside Pkwy, Lawrenceville, GA 30043. The listed phone number is (770) 237-3475.

What is Sports Medicine South Of Gwinnett LLC's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery, specializing in Sports Medicine, with taxonomy code 207XX0005X.

Is Sports Medicine South Of Gwinnett LLC enrolled in Medicare?

Yes. Sports Medicine South Of Gwinnett LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Sports Medicine South Of Gwinnett LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 9 clinicians in 5 Medicare specialties reassign their Medicare billing to Sports Medicine South Of Gwinnett LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Physical Therapist in Private Practice (4), Orthopedic Surgery (2) and Family Practice (1). Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Sports Medicine South Of Gwinnett LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D1085597) is associated with this NPI, valid through June 22, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Sports Medicine South Of Gwinnett LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Sports Medicine South Of Gwinnett LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sports Medicine South Of Gwinnett LLC was last updated on May 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.