NPIMap

Organization Active NPI

Phoebe Dorminy Kids Health

  • Clinic/Center
  • Fitzgerald, GA
National Provider Identifier
1144501867
Registry record updated Sep 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PHOEBE DORMINY KIDS HEALTH
Practice address
119 Norman Dorminy Dr
Ste a
Fitzgerald, GA 31750-8855
Phone
(229) 423-5437
NPI assigned
Sep 8, 2011
Last updated
Sep 8, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
PHOEBE PHYSICIAN GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2011

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

Authorized official

Name
Robert Lagesse
Title
Sr VP Physician Practices
Phone
(229) 312-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

119 Norman Dorminy Dr
Ste a
Fitzgerald, GA 31750-8855

Mailing address

500 W 3Rd Ave
Ste 101
Albany, GA 31701-1985
Phone (229) 312-5800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090121000583 GA Part B Supplier - Clinic/Group Practice 8426112350 Receives reassigned benefits from 1,136 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Phoebe Family Medicinecoffee County26 organizations share this tax ID, including this one
Part of
Phoebe Family Medicinecoffee County

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Locations

126 US Highway 280 W
Americus, GA 31719
Phone (229) 924-6011

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1315440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315440000000",
    "number": "1144501867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W 3RD AVE",
            "address_2": "STE 101",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011985",
            "telephone_number": "229-312-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 NORMAN DORMINY DR",
            "address_2": "STE A",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "317508855",
            "telephone_number": "229-423-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOEBE DORMINY KIDS HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOEBE PHYSICIAN GROUP INC",
        "enumeration_date": "2011-09-08",
        "last_updated": "2011-09-08",
        "status": "A",
        "authorized_official_last_name": "LAGESSE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "SR VP PHYSICIAN PRACTICES",
        "authorized_official_telephone_number": "229-312-1000"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fitzgerald, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; 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.