NPIMap

Organization Active NPI

Colquitt Regional Medical Center

Doing business as Colquitt Regional Medical Center Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Moultrie, GA
National Provider Identifier
1124155965
Registry record updated Oct 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
035296 Issued in GA
Legal business name
COLQUITT REGIONAL MEDICAL CENTER
Doing business as
Colquitt Regional Medical Center Dialysis
Practice address
449 31St Ave SE
Moultrie, GA 31768-7733
Phone
(229) 891-9333
NPI assigned
Feb 28, 2007
Last updated
Oct 28, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
COLQUITT REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 28, 2026

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

Authorized official

Name
Mr. Jim Matney
Title
President/Ceo
Phone
(229) 985-3420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 035296 GA Primary

Addresses

Primary practice location

449 31St Ave SE
Moultrie, GA 31768-7733

Mailing address

3131 S Main St
Moultrie, GA 31768-6925
Phone (229) 985-3420

Other names 1

  • Colquitt Regional Medical Center Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091022000562 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 6204821796 Practice locations: Moultrie, GA

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Colquitt Regional Medical Center DialysisCCN 112314
Overall star rating
1.0 of 5
Ownership
Non-profit
Certified
Mar 6, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
26

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1083566Colquitt Regional Medical Center Dialysis449 31St Avenue SE, Moultrie, GA 31768Certificate of waiverMay 5, 2028

National Provider Directory

National Provider Directory
Tax ID family
Colquitt Regional Med C14 organizations share this tax ID, including this one
Part of
Colquitt Regional Med C

Other organizations with this tax ID 13

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

View all 13

Member organizations 6

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Colquitt Regional Home Care ServicesMoultrie, GA, CCN 117044 Home health agency Operational/Managerial Control Feb 1, 1987
Colquitt Regional HospiceMoultrie, GA, CCN 111542 Hospice 5% Or Greater Direct Ownership Interest (100%) Oct 13, 2015

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1793145600000",
    "number": "1124155965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686925",
            "telephone_number": "229-985-3420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "449 31ST AVE SE",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317687733",
            "telephone_number": "229-891-9333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLQUITT REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLQUITT REGIONAL MEDICAL CENTER",
        "enumeration_date": "2007-02-28",
        "last_updated": "2026-10-28",
        "certification_date": "2026-10-28",
        "status": "A",
        "authorized_official_last_name": "MATNEY",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "229-985-3420",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "035296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colquitt Regional Medical Center Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moultrie, GA

Sources for this page

Verify at the official NPI Registry.