NPIMap

Organization Active NPI

Emanuel County Hospital Authority

Doing business as Ray Medical Clinic

  • Rural Health Clinic/Center
  • Swainsboro, GA
National Provider Identifier
1063832202
Registry record updated Jan 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EMANUEL COUNTY HOSPITAL AUTHORITY
Doing business as
Ray Medical Clinic
Practice address
401 W Main St
Swainsboro, GA 30401-3110
Phone
(478) 237-9928
Fax
(478) 237-4517
NPI assigned
Apr 25, 2014
Last updated
Jan 14, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2015

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

Authorized official

Name
Mr. Steve King
Title
Cfo
Phone
(478) 289-1376

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X GA Primary
Family Medicine Physician 207Q00000X GA

Addresses

Primary practice location

401 W Main St
Swainsboro, GA 30401-3110

Mailing address

PO Box 879
Swainsboro, GA 30401-0879
Phone (478) 289-1303

Other names 1

  • RAY MEDICAL CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091221000668 GA Part A Provider - Rural Health Clinic 3577473040 1 other NPI on this enrollment
Practice locations: Swainsboro, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063832202. Details of each certification follow.

Rural health clinic certification: CCN 118526

Legal name
EMANUEL COUNTY HOSPITAL AUTHORITY
Doing business as
RAY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 4, 2010
Last certification
Mar 21, 2022
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
401 W Main St
Swainsboro, GA 30401-3110
Related CCNs
110109

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Physician Billing Emc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joe L English Individual Corporate Director Aug 1, 2009
Emanuel County Hospital Authority Organization, Swainsboro, GA 5% Or Greater Direct Ownership Interest Jan 1, 2009 100%
Steven E King Individual Corporate OfficerCfo Apr 1, 2013
George Kirk Olsen Individual Corporate DirectorAdministrator Apr 1, 2013
Vijitha P Prasad Individual Corporate Director Jan 1, 2013
Jessica Johnson Individual W-2 Managing Employee May 18, 1987
Paige P Wynn Individual W-2 Managing EmployeeChief Financial Officer Oct 1, 2014

Owners & managing parties with NPI records 10

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Emanuel Medical CenterSwainsboro, GA, CCN 110109 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 14, 2014
Emanuel Medical Center Nursing HomeSwainsboro, GA, CCN 115704 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Swainsboro HealthcareSwainsboro, GA, CCN 118554 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 27, 2014
Swainsboro Internal Medicine ClinicSwainsboro, GA, CCN 118551 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 27, 2014
Twin City Family Medical ClinicTwin City, GA, CCN 118553 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 27, 2014
Porter Family Medical ClinicSwainsboro, GA, CCN 118552 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 27, 2014

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421193600000",
    "number": "1063832202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 879",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304010879",
            "telephone_number": "478-289-1303",
            "fax_number": "478-289-7466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W MAIN ST",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013110",
            "telephone_number": "478-237-9928",
            "fax_number": "478-237-4517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMANUEL COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-25",
        "last_updated": "2015-01-14",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "478-289-1376",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "GA",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RAY MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Swainsboro, GA

Sources for this page

Verify at the official NPI Registry.