Morgan County Georgia Hospital Authority
Organization Active NPI Family Medicine Physician · Madison, GA
NPI 1083080105 · NPPES record last updated Oct 11, 2023
Key facts
- NPI
- 1083080105
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MORGAN COUNTY GEORGIA HOSPITAL AUTHORITY
- Practice address
- 1740 Lions Club Rd
Madison, GA 30650-4762 - Phone
- (706) 438-1275
- Fax
- (706) 438-1278
- NPI assigned
- Aug 12, 2015
- Organization subpart
- No
Authorized official
- Name
- Ralph Amado Castillo
- Title
- Ceo
- Phone
- (706) 752-2247
Owners & managing parties with NPI records 2
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 5
Related certifications (CCN) 1
Practitioners 12
-
Temitope Ibereola Afon, M.D.
-
Sara Danielle Cannington, NP-C
-
Jacob Werkin, M.D.
-
Sergio T Mejias, MD
-
Martin Robert Gallo, M.D.
-
Brittany L Schmitt, CRNA
-
David Mark Weitzman, M.D.
-
Jennifer V Bowers, PA-C
-
Christina E Ross, NP
Affiliated clinicians 90
-
Temitope Ibereola Afon, M.D.
-
Fakhar Ahmad, M.D.
-
William Ashford, MD
-
Joshua Marion Blackmon, M.D.
-
Christine Bohlen, NP
-
Ronald Boulware, MD
-
Jennifer V Bowers, PA-C
-
Kirk Tahama Brown, M.D.
-
Robert Roy Byrne, M.D.
-
Sara Danielle Cannington, NP-C
-
Craig Colby, M.D.
-
Miguel Eduardo Cossio, M.D.
-
Matthew Tyler Crim, MD, MSC, MA
-
Elizabeth Culp, M.D.
-
Maxwell Donnan, DNP
-
David Troy Fletcher, M.D.
-
Frederick Lee Flynt Jr., M.D.
-
Sheba George, MD
-
Jared Todd Griffis, M.D.
-
Parker Charles Grow, M.D.
Medicare Care Compare: Hospital
- Listed as
- Morgan Medical Center
- Type
- Critical Access Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
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
- Government · Non-profit
- Enrollment address
- 1740 Lions Club Rd
Madison, GA 30650-4762
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Morgan County Georgia Hospital Authority |
Operational/Managerial Control | Nov 21, 2007 | |
| Ralph Castillo |
Corporate Officer |
Feb 13, 2013 | |
| W-2 Managing Employee |
Feb 14, 2013 | ||
| Kyle Wilkinson |
W-2 Managing Employee |
Aug 20, 2013 | |
| Patrick Cook |
W-2 Managing Employee |
Mar 11, 2013 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Morgan Medical Center |
Hospital | Operational/Managerial Control | Nov 21, 2007 |
| Morgan Memorial Hospital |
Hospital | Operational/Managerial Control | Nov 21, 2007 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Morgan Physician Services
Locations
1075 S Main St
Ste 100
Madison, GA 30650
Phone (706) 342-3103
1077 S Main St
Madison, GA 30650
Phone (706) 342-0449
1740 Lions Club Rd
Fl 2
Madison, GA 30650
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | GA | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300032394L | Medicaid | GA | |
| CN4526 | Other | GA | MEDICARE |
Other names
- MORGAN MEDICAL CENTER
Other providers in Madison, GA
- Michael Clinton Montgomery
- Moore Health Inc.
- Edmetris Moore-Donald
- William David Moore Sr.
- Morgan County Board of Commissioners HDM
- Morgan County Georgia Hospital Authority
- Morgan County Georgia Hospital Authority
- Morgan County Georgia Hospital Authority
- Morgan County Georgia Hospital Authority
- Morgan County Georgia Hospital Authority
All providers in Madison, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.