NPIMap

Organization Active NPI

Southwest Ga. Nephrology Clinic, P.C.

  • Specialist
  • Albany, GA
National Provider Identifier
1104015569
Registry record updated Aug 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
H708815 Issued in GA
Legal business name
SOUTHWEST GA. NEPHROLOGY CLINIC, P.C.
Practice address
1200 N Jefferson St
Albany, GA 31701-2057
Phone
(229) 888-3970
Fax
(229) 889-9386
NPI assigned
Oct 22, 2007
Last updated
Aug 5, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2015

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

Authorized official

Name
John J. Schilling, M.D.NPI 1841282142
Title
President
Phone
(229) 888-3970

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X H708815 GA Primary

Addresses

Primary practice location

1200 N Jefferson St
Albany, GA 31701-2057

Mailing address

1200 N Jefferson St
Suite B
Albany, GA 31701-2057
Phone (229) 888-3970

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040520000101 GA Part B Supplier - Clinic/Group Practice 3779574686 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
Practice locations: Albany, GA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1200 N Jefferson St
Ste B
Albany, GA 31701
Phone (229) 888-3970

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438732800000",
    "number": "1104015569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N JEFFERSON ST",
            "address_2": "SUITE B",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317012057",
            "telephone_number": "229-888-3970",
            "fax_number": "229-889-9386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N JEFFERSON ST",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317012057",
            "telephone_number": "229-888-3970",
            "fax_number": "229-889-9386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST GA. NEPHROLOGY CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-22",
        "last_updated": "2015-08-05",
        "status": "A",
        "authorized_official_last_name": "SCHILLING",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "229-888-3970",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "H708815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; 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.