NPIMap

Organization Active NPI

PMS 68 LLC

Doing business as d/b/a Grady primary Care

  • Family Medicine Physician
  • Cairo, GA
National Provider Identifier
1124638614
Registry record updated Sep 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PMS 68 LLC
Doing business as
d/b/a Grady primary Care
Practice address
235 1St Ave NE
Cairo, GA 39828-2118
Phone
(229) 378-2214
Fax
(833) 386-7012
NPI assigned
Aug 9, 2020
Last updated
Sep 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2021

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

Authorized official

Name
Dr. Kimberly Ann Harbin, M.DNPI 1790731867
Title
Owner
Phone
(229) 378-2214

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Primary Care Clinic/Center 261QP2300X NU

Addresses

Primary practice location

235 1St Ave NE
Cairo, GA 39828-2118

Mailing address

235 1St Ave NE
Cairo, GA 39828-2118
Phone (229) 378-2214

Other identifiers 1

IdentifierTypeStateIssuer
0009544125MedicaidGA

Other names 1

  • d/b/a Grady primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200924002660 GA Part B Supplier - Clinic/Group Practice 0446679484 Receives reassigned benefits from 5 practitioners
Practice locations: Cairo, GA

National Provider Directory

National Provider Directory

Locations

235 1st Ave NE
Cairo, GA 39828
Phone (229) 254-2117

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1596931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1124638614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 1ST AVE NE",
            "city": "CAIRO",
            "state": "GA",
            "postal_code": "398282118",
            "telephone_number": "229-378-2214",
            "fax_number": "833-386-7012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 1ST AVE NE",
            "city": "CAIRO",
            "state": "GA",
            "postal_code": "398282118",
            "telephone_number": "229-378-2214",
            "fax_number": "833-386-7012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMS 68 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-09",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "HARBIN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-378-2214",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009544125",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "d/b/a Grady primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cairo, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; 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.