NPIMap

Organization Active NPI

The Wiregrass Medical & Surgical Group Inc

  • Family Medicine Physician
  • Donalsonville, GA
National Provider Identifier
1083753404
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
051586 Issued in GA
Legal business name
THE WIREGRASS MEDICAL & SURGICAL GROUP INC
Practice address
804 N Wiley Ave
Donalsonville, GA 39845-1120
Phone
(229) 524-2706
Fax
(229) 524-1272
NPI assigned
Feb 5, 2007
Last updated
Jun 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
April Clanton Massey
Title
Practice Administrator
Phone
(229) 524-2706

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 051586 GA Primary
Internal Medicine Physician 207R00000X 033591 GA
Surgery Physician 208600000X 9288 GA
Surgery Physician 208600000X 019644 GA

Addresses

Primary practice location

804 N Wiley Ave
Donalsonville, GA 39845-1120

Mailing address

804 N Wiley Ave
Donalsonville, GA 39845-1120
Phone (229) 524-2706

Other identifiers 1

IdentifierTypeStateIssuer
GRP8001OtherGAMEDICARE GROUP NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070417000179 GA Part B Supplier - Clinic/Group Practice 8123123387 Receives reassigned benefits from 11 practitioners
Practice locations: Donalsonville, GA

National Provider Directory

National Provider Directory

Locations

804 N Wiley Ave
Donalsonville, GA 39845
Phone (229) 524-2808

Interoperability endpoints

  • Direct secure messaging: andrea.alexander@gadirect.net
  • Direct secure messaging: charles.walker@gadirect.net
  • Direct secure messaging: gregory.hall@gadirect.net
  • Direct secure messaging: homer.breckenridge@gadirect.net
  • Direct secure messaging: joseph.walker@gadirect.net
  • Direct secure messaging: sarah.hampton@gadirect.net

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1083753404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 N WILEY AVE",
            "city": "DONALSONVILLE",
            "state": "GA",
            "postal_code": "398451120",
            "telephone_number": "229-524-2706",
            "fax_number": "229-524-1272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 N WILEY AVE",
            "city": "DONALSONVILLE",
            "state": "GA",
            "postal_code": "398451120",
            "telephone_number": "229-524-2706",
            "fax_number": "229-524-1272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WIREGRASS MEDICAL & SURGICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "MASSEY",
        "authorized_official_first_name": "APRIL",
        "authorized_official_middle_name": "CLANTON",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "229-524-2706"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "051586",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "033591",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "9288",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "019644",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "GRP8001",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Donalsonville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.