NPIMap

Organization Active NPI

Phoebe Worth Medical Center, Inc

  • Rural Health Clinic/Center
  • Ashburn, GA
National Provider Identifier
1144205014
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PHOEBE WORTH MEDICAL CENTER, INC
Practice address
354 E Washington Ave
Ashburn, GA 31714-5222
Phone
(229) 567-3361
NPI assigned
Dec 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Authorized official

Name
Stacey Flynt
Title
Business Office Manager
Phone
(229) 777-4514

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

354 E Washington Ave
Ashburn, GA 31714-5222

Mailing address

PO Box 545
807 S Isabella Street
Sylvester, GA 31791-0545
Phone (229) 567-3361

Other identifiers 1

IdentifierTypeStateIssuer
00002109CMedicaidGA

Other names 1

  • Phoebe Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205000529 GA Part B Supplier - Clinic/Group Practice 0840104527 Receives reassigned benefits from 57 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sylvester, GA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1014 E Franklin St
Sylvester, GA 31791

811 S Isabella St
Sylvester, GA 31791

807 S Isabella St
#B
Sylvester, GA 31791

807 S Isabella St
Ste B
Sylvester, GA 31791

807 S Isabella St
Ste 1
Sylvester, GA 31791

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1144205014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 545",
            "address_2": "807 S ISABELLA STREET",
            "city": "SYLVESTER",
            "state": "GA",
            "postal_code": "317910545",
            "telephone_number": "229-567-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 E WASHINGTON AVE",
            "city": "ASHBURN",
            "state": "GA",
            "postal_code": "317145222",
            "telephone_number": "229-567-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOEBE WORTH MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-13",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "FLYNT",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "229-777-4514"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00002109C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoebe Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ashburn, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; 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.