NPIMap

Individual provider Active NPI

David Israel Mederos, D.O.

  • Hospitalist Physician
  • Thomasville, GA
National Provider Identifier
1154629640
Registry record updated Aug 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
73031 Issued in GA
Practice address
915 Gordon Ave
Thomasville, GA 31792-6614
Phone
(229) 228-2597
NPI assigned
Mar 7, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 10, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 34.011211 OH
Hospitalist Physician 208M00000X 73031 GA Primary

Addresses

Primary practice location

915 Gordon Ave
Thomasville, GA 31792-6614

Mailing address

100 S Madison St
Thomasville, GA 31792-5473

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150318000780 GA Practitioner - Internal Medicine 2062638224 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southland Emergency Medical Services LLCGroup PAC ID 3779701743, 24 clinicians
Southland Hospitalist Group, LLCGroup PAC ID 8022272913, 22 clinicians

Practice addresses (Care Compare)

1155 5TH St SE
Cairo, GA 39828-3142
Phone (229) 200-4950

915 Gordon Ave
Thomasville, GA 31792-6614
Phone (229) 228-2000

Hospital & facility affiliations

  • Archbold Memorial Hospital Hospital, Thomasville, GA, CCN 110038
  • Grady General Hospital Hospital, Cairo, GA, CCN 110121
  • Grady General Hospital Nursing home, CCN 11U121
  • Archbold Brooks Nursing home, CCN 11Z332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
73031GAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southland Emergency Medical Services, L.L.C CurrentSince Jan 9, 2024 Accepting new patients
Southland Bainbridge Hospitalist Group, LLC Hospitalist CurrentSince Mar 11, 2019 Accepting new patients
Southland Hospitalist Group, LLC CurrentSince Jan 1, 2015 Accepting new patients
Hospital Authority of Mitchell County PastSince Oct 1, 2021 Accepting new patients
Grady General Hospital Past Accepting new patients
John D Archbold Memorial Hospital Inc Past Accepting new patients
Brooks County Hospital Past Accepting new patients

Locations

1500 E Shotwell St
Bainbridge, GA 39819
Phone (229) 243-6100

1155 5th St SE
Cairo, GA 39828
Phone (229) 226-3060

90 E Stephens St
Camilla, GA 31730
Phone (229) 200-4950

116 W Thigpen Ave
Lakeland, GA 31635
Phone (229) 482-8440

1221 E McPherson Ave
Nashville, GA 31639
Phone (229) 543-7100

903 N Court St
Quitman, GA 31643
Phone (229) 263-4531

100 S Madison St
Thomasville, GA 31792
Phone (229) 221-9552

915 Gordon Ave
Thomasville, GA 31792
Phone (229) 228-8575

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/66097e3b-7cef-4b96-acca-38bfaae85903/

Organizations & group practices 7

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1299456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439164800000",
    "number": "1154629640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S MADISON ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 GORDON AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926614",
            "telephone_number": "229-228-2597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDEROS",
        "first_name": "DAVID",
        "middle_name": "ISRAEL",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-03-07",
        "last_updated": "2015-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "34.011211",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "73031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thomasville, GA

Sources for this page

Verify at the official NPI Registry.