NPIMap

Organization Active NPI

Internal Medicine Associates of Waycross, P.C.

Doing business as Waycross Internal Medicine

  • Internal Medicine Physician
  • Waycross, GA
National Provider Identifier
1144420530
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INTERNAL MEDICINE ASSOCIATES OF WAYCROSS, P.C.
Doing business as
Waycross Internal Medicine
Practice address
711 Knight Ave
Waycross, GA 31501-1943
Phone
(912) 283-9423
Fax
(912) 283-8204
NPI assigned
Jul 23, 2007
Last updated
Feb 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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

Authorized official

Name
Mrs. Sirena H Cady
Title
Manager
Phone
(912) 283-9423

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X GA Primary

Addresses

Primary practice location

711 Knight Ave
Waycross, GA 31501-1943

Mailing address

711 Knight Ave
Waycross, GA 31501-1943
Phone (912) 283-9423

Other identifiers 1

IdentifierTypeStateIssuer
CG6045OtherRAILROAD MEDICARE GRP NUM

Other names 1

  • Waycross Internal Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040422000277 GA Part B Supplier - Clinic/Group Practice 0749276004 Receives reassigned benefits from 7 practitioners
Practice locations: Waycross, GA

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
11D0265053Waycross Internal Medicine711 Knight Avenue, Waycross, GA 31501ComplianceDec 3, 2027

National Provider Directory

National Provider Directory

Locations

711 Knight Ave
Waycross, GA 31501
Phone (912) 283-9423

Practitioners & affiliated clinicians

Practitioners 10

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": "1185148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1144420530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 KNIGHT AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315011943",
            "telephone_number": "912-283-9423",
            "fax_number": "912-283-8204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 KNIGHT AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315011943",
            "telephone_number": "912-283-9423",
            "fax_number": "912-283-8204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE ASSOCIATES OF WAYCROSS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-23",
        "last_updated": "2022-02-22",
        "certification_date": "2021-05-13",
        "status": "A",
        "authorized_official_last_name": "CADY",
        "authorized_official_first_name": "SIRENA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "912-283-9423",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GRP NUM",
            "identifier": "CG6045",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waycross Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Waycross Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waycross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.