NPIMap

Organization Active NPI

Southern Family Medical Center PC

  • Family Medicine Physician
  • Augusta, GA
National Provider Identifier
1083785349
Registry record updated Dec 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SOUTHERN FAMILY MEDICAL CENTER PC
Practice address
3736 Mike Padgett Hwy Ste a
Augusta, GA 30906-0720
Phone
(706) 560-2273
Fax
(706) 560-0903
NPI assigned
Nov 10, 2006
Last updated
Dec 7, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2012

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

Authorized official

Name
Mike Hodnick
Title
Practice Manager
Phone
(706) 560-2273

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3736 Mike Padgett Hwy Ste a
Augusta, GA 30906-0720

Mailing address

3736 Mike Padgett Hwy Ste a
Augusta, GA 30906-0720
Phone (706) 560-2273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040729000635 GA Part B Supplier - Clinic/Group Practice 5395715056 Receives reassigned benefits from 11 practitioners
Practice locations: Augusta, GA
O20080331000123 SC Part B Supplier - Clinic/Group Practice 5395715056 Receives reassigned benefits from 2 practitioners
Practice locations: North Augusta, SC

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2561/brand/1/csg/1/fhir/r4

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": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354838400000",
    "number": "1083785349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3736 MIKE PADGETT HWY STE A",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309060720",
            "telephone_number": "706-560-2273",
            "fax_number": "706-560-0903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3736 MIKE PADGETT HWY STE A",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309060720",
            "telephone_number": "706-560-2273",
            "fax_number": "706-560-0903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN FAMILY MEDICAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2012-12-07",
        "status": "A",
        "authorized_official_last_name": "HODNICK",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "706-560-2273"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2012; 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.