NPIMap

Organization Active NPI

Macon Cardiovascular Institute

  • Surgery Physician
  • Macon, GA
National Provider Identifier
1104866599
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MACON CARDIOVASCULAR INSTITUTE
Practice address
575 1St St
Macon, GA 31201-2825
Phone
(478) 743-9762
Fax
(478) 746-6612
NPI assigned
Jun 7, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mrs. Lucy F Dermo
Title
Business Manager
Phone
(478) 743-9762

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X

Addresses

Primary practice location

575 1St St
Macon, GA 31201-2825

Mailing address

575 1St St
Macon, GA 31201-2825
Phone (478) 743-9762

National Provider Directory

National Provider Directory

Locations

575 1st St
Macon, GA 31201
Phone (478) 742-7566

306 Corder Rd
Warner Robins, GA 31088
Phone (478) 293-4880

Practitioners & affiliated clinicians

Practitioners 55

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 55

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1104866599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 1ST ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012825",
            "telephone_number": "478-743-9762",
            "fax_number": "478-746-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 1ST ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012825",
            "telephone_number": "478-743-9762",
            "fax_number": "478-746-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACON CARDIOVASCULAR INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "DERMO",
        "authorized_official_first_name": "LUCY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "478-743-9762",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.