Organization Active NPI

Savannah Pediatric Care, LLC

  • Pediatrics Physician
  • Savannah, GA
National Provider Identifier
1124532817
Registry record updated Nov 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SAVANNAH PEDIATRIC CARE, LLC
Practice address
5102 Paulsen St BLDG 3
Savannah, GA 31405-4614
Phone
(912) 350-7914
NPI assigned
Nov 17, 2017
Last updated
Nov 17, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2017

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

Authorized official

Name
Robert A Faile
Title
Vice President
Phone
(843) 856-7923

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Pediatric Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0207X

Addresses

Primary practice location

5102 Paulsen St BLDG 3
Savannah, GA 31405-4614

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4525
Phone (615) 372-5426

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180622000096 GA Part B Supplier - Clinic/Group Practice 8921353954 Receives reassigned benefits from 28 practitioners
Practice locations: Savannah, GA; Statesboro, GA; Dublin, GA

National Provider Directory

National Provider Directory

Locations

4700 Waters Ave
Ste 300
Savannah, GA 31404
Phone (912) 350-5646

4750 Waters Ave
Savannah, GA 31404
Phone (912) 350-8193

14 Okatie Center Blvd S
#101
Okatie, SC 29909
Phone (843) 836-3800

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1510876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510876800000",
    "number": "1124532817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274525",
            "telephone_number": "615-372-5426",
            "fax_number": "866-831-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5102 PAULSEN ST BLDG 3",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314054614",
            "telephone_number": "912-350-7914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAVANNAH PEDIATRIC CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-17",
        "last_updated": "2017-11-17",
        "status": "A",
        "authorized_official_last_name": "FAILE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "843-856-7923"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2017; 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.