NPIMap

Organization Active NPI

Morgan County Georgia Hospital Authority

Doing business as Morgan Medical Center

  • Family Medicine Physician
  • Madison, GA
National Provider Identifier
1083080105
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MORGAN COUNTY GEORGIA HOSPITAL AUTHORITY
Doing business as
Morgan Medical Center
Practice address
1740 Lions Club Rd
Madison, GA 30650-4762
Phone
(706) 438-1275
Fax
(706) 438-1278
NPI assigned
Aug 12, 2015
Last updated
Oct 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Authorized official

Name
Ralph Amado Castillo
Title
Ceo
Phone
(706) 752-2247

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X GA Primary

Addresses

Primary practice location

1740 Lions Club Rd
Madison, GA 30650-4762

Mailing address

1740 Lions Club Rd
Madison, GA 30650-4762
Phone (706) 438-1275

Other identifiers 2

IdentifierTypeStateIssuer
300032394LMedicaidGA
CN4526OtherGAMEDICARE

Other names 1

  • MORGAN MEDICAL CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040309001118 GA Part B Supplier - Clinic/Group Practice 0446148597 Receives reassigned benefits from 12 practitioners
Practice locations: Madison, GA
O20080523000137 GA Part A Provider - Critical Access Hospital 0446148597 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Madison, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083080105. Details of each certification follow.

Hospital certification: CCN 111304

Legal name
MORGAN COUNTY GEORGIA HOSPITAL AUTHORITY
Doing business as
MORGAN MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 20, 1999
Last certification
Dec 10, 2024
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Enrollment address
1740 Lions Club Rd
Madison, GA 30650-4762

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

Other NPIs with the same Medicare PAC ID 2

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.

Care Compare: Hospital

Medicare Care Compare
Listed as
Morgan Medical CenterCCN 111304 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Morgan Co Ga Hospital Auth6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1075 S Main St
Ste 100
Madison, GA 30650
Phone (706) 438-1275

1740 Lions Club Rd
Fl 2
Madison, GA 30650

1740 Lions Club Rd
Ste 100
Madison, GA 30650
Phone (706) 752-2373

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Morgan County Georgia Hospital Authority Organization, Madison, GA Operational/Managerial Control Nov 21, 2007
Ralph Castillo Individual Corporate OfficerCeo Feb 13, 2013
W-2 Managing EmployeeCeo Feb 14, 2013
Kyle Wilkinson Individual W-2 Managing EmployeeCfo Aug 20, 2013
Patrick Cook Individual W-2 Managing EmployeeCoo Mar 11, 2013

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Morgan Medical CenterMadison, GA, CCN 111304 Hospital Operational/Managerial Control Nov 21, 2007
Morgan Memorial HospitalMadison, GA, CCN 11Z304 Hospital Operational/Managerial Control Nov 21, 2007

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 90

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 90

NPI Registry JSON

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

{
    "created_epoch": "1439337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696982400000",
    "number": "1083080105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 LIONS CLUB RD",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306504762",
            "telephone_number": "706-438-1275",
            "fax_number": "706-438-1278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 LIONS CLUB RD",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306504762",
            "telephone_number": "706-438-1275",
            "fax_number": "706-438-1278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORGAN COUNTY GEORGIA HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-12",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "AMADO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-752-2247"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300032394L",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CN4526",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MORGAN MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, GA

Sources for this page

Verify at the official NPI Registry.