NPIMap

Organization Active NPI

Grady General Hospital

  • Diagnostic Radiology Physician
  • Cairo, GA
National Provider Identifier
1093178485
Registry record updated Aug 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
GRADY GENERAL HOSPITAL
Practice address
1155 5TH St SE
Cairo, GA 39828
Phone
(229) 377-1150
NPI assigned
Apr 1, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2018

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

Authorized official

Name
Mr. Gregory S. Hembree
Title
Senior Vice President and Cfo
Phone
(229) 228-2880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

1155 5TH St SE
Cairo, GA 39828

Mailing address

920 Cairo Rd
Thomasville, GA 31792-4255
Phone (229) 228-8800

Other names 1

  • Grady General Hospital - vRadFL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161202001411 FL Part B Supplier - Clinic/Group Practice 7618866518 Receives reassigned benefits from 3 practitioners
Practice locations: Lakewood Ranch, FL; Palm City, FL; Ponte Vedra Beach, FL

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Stephen W Pearce Crna5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Archbold Grady SwingbedCairo, GA, CCN 11U121 Hospital 5% Or Greater Direct Ownership Interest Apr 23, 2014

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1459468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535500800000",
    "number": "1093178485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 CAIRO RD",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317924255",
            "telephone_number": "229-228-8800",
            "fax_number": "229-228-8892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 5TH ST SE",
            "city": "CAIRO",
            "state": "GA",
            "postal_code": "39828",
            "telephone_number": "229-377-1150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRADY GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-01",
        "last_updated": "2018-08-29",
        "status": "A",
        "authorized_official_last_name": "HEMBREE",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "229-228-2880",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grady General Hospital - vRadFL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cairo, GA

Sources for this page

Verify at the official NPI Registry.