Active NPI
Raymond J Otis Sr., M.D.
- Family Medicine Physician
- Camilla, GA
National Provider Identifier
1104844422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 042685
- Practice address
- 24 N Ellis St
Camilla, GA 31730-1502 - Phone
- (229) 336-7343
- Fax
- (229) 336-7400
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 042685 | GA | Primary |
Addresses
Primary practice location
24 N Ellis St
Camilla, GA 31730-1502
Mailing address
PO Box 348
24 North Ellis Street
Camilla, GA 31730-0348
Phone (229) 336-7343
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031205000149 | GA | Practitioner - Family Practice | 6608771852 | Reassigns benefits to 4 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 1993
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
24 N Ellis St
Camilla, GA 31730-1502
Phone (229) 336-7343
Hospital & facility affiliations
- Bacon County Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042685 | GA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospital Authority of the City of Bainbridge and Decatur County Georgi | Current | Accepting new patients | |
| Dr Raymond J Otis Sr PC | Family Medicine | Current | Accepting new patients |
| Clinch County Hospital Authority | Current | Accepting new patients | |
| The Urology Institute Ambulatory Surgery Center | Current | Accepting new patients | |
| Hospital Authority of the City of Bainbridge and Decatur County | Current | Accepting new patients | |
| The Baxley and Appling County Hospital Authority | Past | Accepting new patients |
Locations
302 S Wayne St
Alma, GA 31510
Phone (912) 632-8961
1500 E Shotwell St
Bainbridge, GA 39819
Phone (229) 243-6100
163 E Tollison St
Baxley, GA 31513
Phone (912) 367-9847
1155 5th St SE
Cairo, GA 39828
Phone (229) 226-3060
24 N Ellis St
Camilla, GA 31730
Phone (229) 336-0071
1050 Valdosta Hwy
Homerville, GA 31634
Phone (912) 383-6575
Organizations & group practices 7
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Bainbridge, GA
- NPI 1053388256
GA
-
- Multi-Specialty Clinic/Center
- Bainbridge, GA
- NPI 1548788771
-
- Ambulatory Surgical Clinic/Center
- Thomasville, GA
- NPI 1881704773
-
- Rural Health Clinic/Center
- Baxley, GA
- NPI 1073752143
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716249600000",
"number": "1104844422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 348",
"address_2": "24 NORTH ELLIS STREET",
"city": "CAMILLA",
"state": "GA",
"postal_code": "317300348",
"telephone_number": "229-336-7343",
"fax_number": "229-336-7400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 N ELLIS ST",
"city": "CAMILLA",
"state": "GA",
"postal_code": "317301502",
"telephone_number": "229-336-7343",
"fax_number": "229-336-7400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTIS",
"first_name": "RAYMOND",
"middle_name": "J",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2024-05-21",
"certification_date": "2024-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "042685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camilla, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.