Active NPI
Screven County Hospital LLC
- Medicare Defined Swing Bed Hospital Unit
- Sylvania, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medicare Defined Swing Bed Hospital Unit
- License
- 124-164
- Legal business name
- SCREVEN COUNTY HOSPITAL LLC
- Practice address
- 215 Mims Rd
Sylvania, GA 30467-1994 - Phone
- (912) 564-7426
- Fax
- (912) 564-0010
- NPI assigned
- Nov 16, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- David Alex Villa
- Title
- Ceo
- Phone
- (760) 468-7765
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 124-164 | GA | Primary |
Addresses
Primary practice location
215 Mims Rd
Sylvania, GA 30467-1994
Mailing address
460 Mall Blvd Ste B
Savannah, GA 31406-4891
Phone (912) 644-5300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000001647S | Medicaid | GA |
Other names 1
- Optim Medical Center - Screven
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110118000712 | GA | Part A Provider - Critical Access Hospital | 5496944712 | Practice locations: Sylvania, GA |
| O20110321000565 | GA | Part B Supplier - Clinic/Group Practice | 5496944712 |
Receives reassigned benefits from 4 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Millen, GA; Sylvania, GA |
Hospital certification: CCN 11Z312
- Legal name
- SCREVEN COUNTY HOSPITAL LLC
- Doing business as
- OPTIM MEDICAL CENTER - SCREVEN
- Organization structure
- LLC
- Incorporated
- Jun 28, 2010 in GA
- Enrollment address
- 215 Mims Rd
Sylvania, GA 30467-1994
Related certifications (CCN) 1
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 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Screven Cty Hospital LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Diagnostic Radiology Physician
- Cleveland, MS
- NPI 1699692319
Locations
209B Mims Rd
Sylvania, GA 30467
Phone (912) 564-7426
211 Mims Rd
Sylvania, GA 30467
Phone (912) 564-2779
Ownership & related parties
All disclosed owners & managing parties 12
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| SP Holdco I Inc | 5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
| National Surgical Hospitals, LLC | 5% Or Greater Indirect Ownership Interest | May 31, 2015 | 100% |
| Jennifer B Baldock | Corporate Officer | Sep 1, 2017 | |
| Bcpe Seminole Holdings, LP | 5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 66.4% |
| Community Hospital Management Company LLC | 5% Or Greater Direct Ownership Interest | Jul 1, 2010 | 100% |
| Surgery Partners Inc | 5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
| Community Hospital Holding Company, LLC | 5% Or Greater Indirect Ownership Interest | Jul 1, 2010 | 100% |
| Surgery Center Holdings Inc | 5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
| David Alex Villa | Corporate Officer | Oct 10, 2024 | |
| W-2 Managing Employee | Oct 1, 2024 | ||
| Bradley R Owens | Other | Dec 2, 2019 | |
| NSH Georgia Inc | 5% Or Greater Indirect Ownership Interest | May 31, 2015 | |
| Surgery Center Holdings LLC | 5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Optim Primary Care- Slyvania | Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Nov 7, 2011 Sep 1, 2017 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Rural Health Clinic/Center
- Sylvania, GA
- NPI 1841432044
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
Facilities with the same owner 23
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Rural Health Clinic/Center
- Sylvania, GA
- NPI 1841432044
Bcpe Seminole Holdings, LP, Community Hospital Holding Company, LLC, National Surgical Hospitals, LLC, NSH Georgia Inc, SP Holdco I Inc, Surgery Center Holdings Inc, Surgery Center Holdings LLC, Surgery Partners Inc
-
- Rural Health Clinic/Center
- Millen, GA
- NPI 1033428214
Bcpe Seminole Holdings, LP, Community Hospital Holding Company, LLC, Community Hospital Management Company LLC, National Surgical Hospitals, LLC, NSH Georgia Inc, SP Holdco I Inc, Surgery Center Holdings Inc, Surgery Center Holdings LLC, Surgery P
-
- Critical Access Hospital
- Sylvania, GA
- NPI 1225339898
Bcpe Seminole Holdings, LP, Community Hospital Holding Company, LLC, Community Hospital Management Company LLC, National Surgical Hospitals, LLC, NSH Georgia Inc, SP Holdco I Inc, Surgery Center Holdings Inc, Surgery Center Holdings LLC, Surgery P
-
- Medicare Defined Swing Bed Hospital Unit
- Reidsville, GA
- NPI 1740440932
Bcpe Seminole Holdings, LP, Community Hospital Holding Company, LLC, National Surgical Hospitals, LLC, NSH Georgia Inc, SP Holdco I Inc, Surgery Center Holdings Inc, Surgery Center Holdings LLC, Surgery Partners Inc
-
- Rural Health Clinic/Center
- Metter, GA
- NPI 1285132415
Bcpe Seminole Holdings, LP, Community Hospital Holding Company, LLC, National Surgical Hospitals, LLC, NSH Georgia Inc, SP Holdco I Inc, Surgery Center Holdings Inc, Surgery Center Holdings LLC, Surgery Partners Inc
-
- Rural Health Clinic/Center
- Reidsville, GA
- NPI 1285893818
Bcpe Seminole Holdings, LP, Community Hospital Holding Company, LLC, National Surgical Hospitals, LLC, NSH Georgia Inc, SP Holdco I Inc, Surgery Center Holdings Inc, Surgery Center Holdings LLC, Surgery Partners Inc
-
- Critical Access Hospital
- Reidsville, GA
- NPI 1790942381
Bcpe Seminole Holdings, LP, Community Hospital Holding Company, LLC, National Surgical Hospitals, LLC, NSH Georgia Inc, SP Holdco I Inc, Surgery Center Holdings Inc, Surgery Center Holdings LLC, Surgery Partners Inc
-
- Rural Health Clinic/Center
- Glennville, GA
- NPI 1972762508
Bcpe Seminole Holdings, LP, Community Hospital Holding Company, LLC, National Surgical Hospitals, LLC, NSH Georgia Inc, SP Holdco I Inc, Surgery Center Holdings Inc, Surgery Center Holdings LLC, Surgery Partners Inc
-
- General Acute Care Hospital
- Durango, CO
- NPI 1508842964
Bcpe Seminole Holdings, LP, SP Holdco I Inc, Surgery Center Holdings Inc, Surgery Center Holdings LLC, Surgery Partners Inc
-
- General Acute Care Hospital
- Mesa, AZ
- NPI 1396745832
Bcpe Seminole Holdings, LP, National Surgical Hospitals, LLC, SP Holdco I Inc, Surgery Center Holdings Inc, Surgery Center Holdings LLC, Surgery Partners Inc
-
- General Acute Care Hospital
- Bryan, TX
- NPI 1801817135
National Surgical Hospitals, LLC, SP Holdco I Inc, Surgery Center Holdings Inc, Surgery Center Holdings LLC, Surgery Partners Inc
-
- General Acute Care Hospital
- Great Falls, MT
- NPI 1639109978
Bcpe Seminole Holdings, LP, SP Holdco I Inc, Surgery Center Holdings Inc, Surgery Center Holdings LLC, Surgery Partners Inc
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Millen, GA
- NPI 1497911937
-
- Physician Assistant
- Millen, GA
- NPI 1144671769
-
- Family Nurse Practitioner
- Sylvania, GA
- NPI 1679516777
-
- Family Medicine Physician
- Sylvania, GA
- NPI 1992940258
-
- Sports Medicine (Orthopaedic Surgery) Physician
- Savannah, GA
- NPI 1891766978
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Family Medicine Physician
- Sylvania, GA
- NPI 1992940258
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1289865600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1733443200000",
"number": "1083915524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "460 MALL BLVD STE B",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314064891",
"telephone_number": "912-644-5300",
"fax_number": "912-644-5260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 MIMS RD",
"city": "SYLVANIA",
"state": "GA",
"postal_code": "304671994",
"telephone_number": "912-564-7426",
"fax_number": "912-564-0010"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SCREVEN COUNTY HOSPITAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2010-11-16",
"last_updated": "2024-12-06",
"certification_date": "2024-12-06",
"status": "A",
"authorized_official_last_name": "VILLA",
"authorized_official_first_name": "DAVID ALEX",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "760-468-7765"
},
"taxonomies": [
{
"code": "275N00000X",
"taxonomy_group": "",
"desc": "Medicare Defined Swing Bed Unit",
"state": "GA",
"license": "124-164",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000001647S",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Optim Medical Center - Screven",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Sylvania, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.