Carolyn Kinzer-Bezanson Wall, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

038275 Issued in GA

Practice address

203 Indigo Drive
Southeastern Pathology Associates, PC
Brunswick, GA 31525

Phone

(912) 279-1900

Fax

(912) 261-0753

NPI assigned

Dec 6, 2005

Last updated

Dec 5, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 8

Other names 1

• Carolyn A Kinzer-Bezanson Other name

Medicare fee-for-service enrollment

Enrolled in GA, FL, SC3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Pathology

Education

Medical College of Georgia School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeastern Pathology Associates PCGroup PAC ID 5890781371, shared by 2 NPIs, 45 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• East Georgia Regional Medical Center Hospital, Statesboro, GA, CCN 110075
• Southeast Georgia Health System- Brunswick Campus Hospital, Brunswick, GA, CCN 110025
• Effingham Health System Hospital, Springfield, GA, CCN 111306
• Jeff Davis Hospital Hospital, Hazlehurst, GA, CCN 111333
• Piedmont Columbus Regional Midtown Hospital, Columbus, GA, CCN 110064

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25282/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southeastern Pathology Associates PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Brunswick, GA
  • NPI 1821104704
  Medicare reassignment NPD
• Southeastern Pathology Associates PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Brunswick, GA
  • NPI 1992963268

  FL

  Medicare reassignment NPD
• Coastal Care Inc

  • Primary Care Clinic/Center
  • Waycross, GA
  • NPI 1538367149
  NPD (past)
• Jefferson Clinic, P.C.

  • Internal Medicine Physician
  • Birmingham, AL
  • NPI 1124086509

  Anatomic Pathology & Clinical Pathology

  NPD (past)
• Norwood Clinic Inc

  • Multi-Specialty Clinic/Center
  • Birmingham, AL
  • NPI 1104879741
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• East Georgia Regional Medical Center, LLC

  • General Acute Care Hospital
  • Statesboro, GA
  • NPI 1265486278
  Care Compare affiliation
• Effingham Hospital, Inc.

  dba Effingham Health System

  • Critical Access Hospital
  • Springfield, GA
  • NPI 1811962756
  Care Compare affiliation
• Hospital Authority of Jeff Davis County Georgia

  dba Jeff Davis Hospital

  • Critical Access Hospital
  • Hazlehurst, GA
  • NPI 1912902263
  Care Compare affiliation
• Southeast Georgia Health System, Inc.

  dba Southeast Georgia Health System - Brunswick Campus

  • General Acute Care Hospital
  • Brunswick, GA
  • NPI 1598784720
  Care Compare affiliation
• The Medical Center Inc

  dba Piedmont Columbus Regional Midtown

  • General Acute Care Hospital
  • Columbus, GA
  • NPI 1255401519
  Care Compare affiliation

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417737600000",
    "number": "1124002712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30309",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29417",
            "telephone_number": "843-554-9300",
            "fax_number": "843-566-8780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 INDIGO DRIVE",
            "address_2": "SOUTHEASTERN PATHOLOGY ASSOCIATES, PC",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "31525",
            "telephone_number": "912-279-1900",
            "fax_number": "912-261-0753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "CAROLYN",
        "middle_name": "KINZER-BEZANSON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-06",
        "last_updated": "2014-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": "038275",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "ME85489",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "SC",
            "license": "MD29387",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AL",
            "license": "MD317652",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "LA",
            "license": "MD.12093R/INACTIVE",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000931356A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000931356D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000931356E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000931356F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000931356",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000931356B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000931356C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000931356I",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "KINZER-BEZANSON",
            "middle_name": "A",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Walgreen Co (Walgreens #10266)
• Walgreen Co (Rite Aid #11850)
• Walgreen Co (Walgreens #07848)
• Logan Mullis Walker
• Vanessa Walker
• Gina Wallace
• Haley Rebecca Walling, NP
• Jeanne Marie Walling
• Tonya Walsh
• Diana L. Walther, PH.D.

• Anatomic Pathology & Clinical Pathology Physician in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Anatomic Pathology & Clinical Pathology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2014; 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.

Verify at the official NPI Registry.