Jack Bradley Royal, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

TRN17253 Issued in FL

Practice address

902 N 7TH St
Cordele, GA 31015-3234

Phone

(229) 276-3100

NPI assigned

Jun 27, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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 1

Specialty

Anesthesiology

Education

Medical College of Georgia School of Medicine

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ams Southeast LLCGroup PAC ID 3870880792, 83 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Crisp Regional Hospital Hospital, Cordele, GA, CCN 110104

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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

• Ams Southeast LLC

  • Anesthesiology Physician
  • Pensacola, FL
  • NPI 1487107157

  GA

  Medicare reassignment Care Compare group NPD
• Crisp Regional Hospital Inc

  • General Acute Care Hospital
  • Cordele, GA
  • NPI 1700851649
  Medicare reassignment NPD
• South Georgia Anesthesia Associates, PC

  • Pain Medicine (Anesthesiology) Physician
  • Thomasville, GA
  • NPI 1285605733
  Medicare reassignment NPD
• Crisp Regional Hospital, Inc

  • Long Term Care Pharmacy
  • Cordele, GA
  • NPI 1679836142
  NPD

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

• Crisp Regional Hospital Inc

  • General Acute Care Hospital
  • Cordele, GA
  • NPI 1700851649
  Care Compare affiliation

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

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616284800000",
    "number": "1134483878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 E 3RD AVE",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310153208",
            "telephone_number": "229-271-4656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 N 7TH ST",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310153234",
            "telephone_number": "229-276-3100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 SW Archer Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326103003",
            "country_code": "US",
            "telephone_number": "352-265-0077",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROYAL",
        "first_name": "JACK",
        "middle_name": "BRADLEY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-27",
        "last_updated": "2021-03-21",
        "certification_date": "2021-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "TRN17253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003180038C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Strange Revell, FNP
• Nancy Parker Rigdon
• Guido H Ring, MD
• Kristin S Rischar, MD
• Kristiansson Roth, PH.D.
• Sule A Salami, M.D.
• Franklin Alexy Saliba, CRNA
• Rebecca Sawyer
• Scot a. Wall, MD, PC
• Vishal Sharma, MD

• Anesthesiology Physician in Cordele, GA
• Providers in Cordele, GA by specialty
• Anesthesiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2021; 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.