1. Home
  2. Directory
  3. Alabama
  4. Jacksonville
  5. Surgery
  6. NPI Profile

SURGERY CLINIC, LLC - JACKSONVILLE
NPI 1780068460
Surgery in Jacksonville, AL

Active since July 13, 2015
1622 CHURCH AVE SE, JACKSONVILLE, AL 36265(256) 547-6331(256) 547-1711 Get Directions Write a Review

NPPES record last updated: February 10, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Surgery Clinic, Llc - Jacksonville NPPES

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

SURGERY CLINIC, LLC - JACKSONVILLE (NPI 1780068460) is a healthcare organization registered as a surgery in Jacksonville, Alabama and active in the NPI registry since July 2015. The organization lists Dianette Keener, Billing Manager, as its authorized official.

NPPES Registry Identity

NPI1780068460
Entity TypeOrganization
Primary Taxonomy208600000X
Legal Business NameSURGERY CLINIC, LLC
Location Address1622 CHURCH AVE SEJacksonville, AL 36265-3200
Mailing Address419 S 5th StGadsden, AL 35901-5101 · (256) 547-6331 · Fax (256) 547-1711
Phone(256) 547-6331
Fax(256) 547-1711
Organization SubpartYes
Authorized OfficialDianette KeenerBilling Manager · (256) 547-6331
Enumeration DateJuly 13, 2015
Last NPPES UpdateFebruary 10, 2021
NPPES CertifiedFebruary 10, 2021
✔ NPI 1780068460 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
1622 CHURCH AVE SE, Jacksonville, AL 36265
Open in Google Maps ↗

Other Names 1

Doing Business AsSurgery Clinic, Llc - Jacksonville

Other Identifiers 1

Medicaid528202650AL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Surgery Clinic, Llc - Jacksonville is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Surgery Clinic, LLC - Jacksonville, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (3)

Charles Newman, M.D.
General Surgery
NPI 1093772162
419 S 5TH ST
Gadsden, AL 35901
(256) 547-6331
✔ PECOS✔ Accepts Medicare21 mi
Lucian Newman, M.D.
General Surgery
NPI 1639136716
419 S 5TH ST
Gadsden, AL 35901
(256) 547-6331
✔ PECOS✔ Accepts Medicare21 mi
Paul Nordness, M.D.
General Surgery
NPI 1760456941
419 S 5TH ST
Gadsden, AL 35901
(256) 547-6331
✔ PECOS✔ Accepts Medicare21 mi

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

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 Surgery Clinic, LLC's NPI number?

The NPI number for Surgery Clinic, LLC is 1780068460. It was assigned to this organization in the NPPES registry on July 13, 2015. The provider is doing business as Surgery Clinic, LLC - Jacksonville.

Where is Surgery Clinic, LLC located?

Surgery Clinic, LLC is located at 1622 Church Ave SE, Jacksonville, AL 36265. The listed phone number is (256) 547-6331.

What is Surgery Clinic, LLC's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Surgery Clinic, LLC enrolled in Medicare?

Yes. Surgery Clinic, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Surgery Clinic, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in General Surgery, reassign their Medicare billing to Surgery Clinic, 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Surgery Clinic, LLC was last updated on February 10, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.