St. Mary's Medical Group, Inc.

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

Legal business name

ST. MARY'S MEDICAL GROUP, INC.

Practice address

1360 Caduceus Way BLDG 200-102
Watkinsville, GA 30677-7349

Phone

(706) 389-3810

Fax

(706) 389-3811

NPI assigned

Jun 2, 2020

Last updated

Nov 1, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brittainy Horne

Title

President

Phone

(706) 389-3940

Specialties & licenses 1

Addresses

Other names 1

• St. Mary's Allergy Specialists Other name

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs on the same Medicare enrollment 28

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• St Mary's Medical Group, Inc

  • Cardiovascular Disease Physician
  • Athens, GA
  • NPI 1376711333

  O20080616000388

  Same enrollment
• St. Mary's Medical Group, Inc

  • Neurology Physician
  • Watkinsville, GA
  • NPI 1538393301

  O20080616000388

  Same enrollment
• St. Mary's Medical Group, Inc.

  • Rheumatology Physician
  • Watkinsville, GA
  • NPI 1003264524

  O20080616000388

  Same enrollment
• St. Mary's Medical Group, Inc.

  • Neurological Surgery Physician
  • Athens, GA
  • NPI 1083189591

  O20080616000388

  Same enrollment
• St. Mary's Medical Group, Inc.

  • Infectious Disease Physician
  • Athens, GA
  • NPI 1144641747

  O20080616000388

  Same enrollment
• St. Mary's Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • Athens, GA
  • NPI 1154117190

  O20080616000388

  Same enrollment
• St. Mary's Medical Group, Inc.

  • Internal Medicine Physician
  • Athens, GA
  • NPI 1174914873

  O20080616000388

  Same enrollment
• St. Mary's Medical Group, Inc.

  • Internal Medicine Physician
  • Athens, GA
  • NPI 1184913733

  O20080616000388

  Same enrollment
• St. Mary's Medical Group, Inc.

  • Family Medicine Physician
  • Watkinsville, GA
  • NPI 1235543513

  O20080616000388

  Same enrollment
• St. Mary's Medical Group, Inc.

  • Internal Medicine Physician
  • Athens, GA
  • NPI 1235561820

  O20080616000388

  Same enrollment
• St. Mary's Medical Group, Inc.

  dba St. Mary's Primary Care

  • Family Medicine Physician
  • Athens, GA
  • NPI 1265850614

  O20080616000388

  Same enrollment
• St. Mary's Medical Group, Inc.

  • Family Medicine Physician
  • Bogart, GA
  • NPI 1285116210

  O20080616000388

  Same enrollment

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

{
    "created_epoch": "1591056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667260800000",
    "number": "1053935411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 48089",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306048089",
            "telephone_number": "706-389-3740",
            "fax_number": "706-389-3951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 CADUCEUS WAY BLDG 200-102",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777349",
            "telephone_number": "706-389-3810",
            "fax_number": "706-389-3811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-02",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A",
        "authorized_official_last_name": "HORNE",
        "authorized_official_first_name": "BRITTAINY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-389-3940"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary's Allergy Specialists",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Squier Consulting, LLC
• Shea Squier, LCSW
• St. Mary's Highland Hills, Inc. (Highland Hills Village)
• St. Mary's Medical Group, Inc
• St. Mary's Medical Group, Inc.
• St. Mary's Medical Group, Inc.
• St. Mary's Medical Group, Inc.
• St. Mary's Medical Group, Inc.
• Laura Esther Starling, NP
• Matthew Steele, MD

• Allergy & Immunology Physician in Watkinsville, GA
• Providers in Watkinsville, GA by specialty
• Allergy & Immunology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.