Individual provider Active NPI

Thomas Reagan Wolf, M.D.

  • Emergency Medicine Physician
  • Rincon, GA
National Provider Identifier
1013173822
Registry record updated Aug 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
4301092890 Issued in MI
Practice address
5629 Hwy 21 S
Rincon, GA 31326-9416
Phone
(912) 295-2133
Fax
(912) 295-5924
NPI assigned
Jul 31, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4301092890 MI Primary

Addresses

Primary practice location

5629 Hwy 21 S
Rincon, GA 31326-9416

Mailing address

5629 Hwy 21 S
Rincon, GA 31326-9416
Phone (912) 295-2133

Other practice location 1

6071 W Outer Dr
Detroit, MI 48235-2624
Phone (313) 966-1020

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110805000026 GA Practitioner - Emergency Medicine 0143499301 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acs Primary Care Physicians - Southeast PCGroup PAC ID 5193620714, 409 clinicians
Emergency Physicians IncGroup PAC ID 7911811435, 105 clinicians

Practice addresses (Care Compare)

1900 Tebeau St
Waycross, GA 31501-6357
Phone (912) 283-3030

2415 Parkwood Dr
Brunswick, GA 31520-4722
Phone (912) 466-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
98
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301092890MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Emergency Associates Emergency Medicine CurrentSince Jul 1, 2011 Accepting new patients
Emergency Physicians Inc Emergency Medicine CurrentSince Sep 15, 2016 Accepting new patients
Advanced Pediatric Specialists LLC Past Accepting new patients

Locations

2415 Parkwood Dr
Brunswick, GA 31520
Phone (912) 466-4079

5629 Highway 21 S
Rincon, GA 31326
Phone (912) 295-2133

11705 Mercy Blvd
Savannah, GA 31419
Phone (912) 819-2452

5353 Reynolds St
Savannah, GA 31405
Phone (912) 692-6172

1499 Fair Rd
Statesboro, GA 30458
Phone (912) 486-1000

Organizations & group practices 4

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

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": "1217462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565308800000",
    "number": "1013173822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5629 HWY 21 S",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313269416",
            "telephone_number": "912-295-2133",
            "fax_number": "912-295-5924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5629 HWY 21 S",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313269416",
            "telephone_number": "912-295-2133",
            "fax_number": "912-295-5924"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6071 W Outer Dr",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482352624",
            "country_code": "US",
            "telephone_number": "313-966-1020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLF",
        "first_name": "THOMAS",
        "middle_name": "REAGAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-31",
        "last_updated": "2019-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301092890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rincon, GA

Sources for this page

Verify at the official NPI Registry.