NPIMap

Organization Active NPI

Clinch County Hospital Authority

Doing business as Clinch Memorial Family Practice

  • Primary Care Clinic/Center
  • Homerville, GA
National Provider Identifier
1154895969
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CLINCH COUNTY HOSPITAL AUTHORITY
Doing business as
Clinch Memorial Family Practice
Practice address
80 Huxford St
Homerville, GA 31634-2356
Phone
(912) 487-5211
NPI assigned
Jan 15, 2019
Last updated
Jan 15, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
CLINCH COUNTY HOSPITAL AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

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

Authorized official

Name
Cassandra C Hughes
Title
Cfo
Phone
(912) 487-5211

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

80 Huxford St
Homerville, GA 31634-2356

Mailing address

PO Box 298
Homerville, GA 31634-0298
Phone (912) 487-5211

Other names 1

  • Clinch Memorial Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040329000922 GA Part B Supplier - Clinic/Group Practice 7416849922 Receives reassigned benefits from 103 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fargo, GA; Homerville, GA

Other NPIs on the same Medicare enrollment 1

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

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
11D2180890Clinch Memorial Family Practice80 Huxford Street, Homerville, GA 31634Certificate of waiverMar 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Oguchi Nwosu MD2 organizations share this tax ID, including this one
Part of
Oguchi Nwosu MD

Other organizations with this tax ID 1

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

Locations

80 Huxford St
Homerville, GA 31634
Phone (912) 470-2273

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1547510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547510400000",
    "number": "1154895969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 298",
            "city": "HOMERVILLE",
            "state": "GA",
            "postal_code": "316340298",
            "telephone_number": "912-487-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 HUXFORD ST",
            "city": "HOMERVILLE",
            "state": "GA",
            "postal_code": "316342356",
            "telephone_number": "912-487-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINCH COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLINCH COUNTY HOSPITAL AUTHORITY",
        "enumeration_date": "2019-01-15",
        "last_updated": "2019-01-15",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "912-487-5211"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinch Memorial Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Homerville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; 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.