Active NPI
Oglethorpe Ear, Nose & Throat, LLC
- Otolaryngology Physician
- Lexington, GA
National Provider Identifier
1164076600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- Legal business name
- OGLETHORPE EAR, NOSE & THROAT, LLC
- Practice address
- 219 West Boggs Street
Lexington, GA 30648 - Phone
- (706) 743-0006
- Fax
- (706) 740-6073
- NPI assigned
- Aug 1, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Matt Pitts
- Title
- Administrator
- Phone
- (706) 743-0006
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | Primary |
Addresses
Primary practice location
219 West Boggs Street
Lexington, GA 30648
Mailing address
219 W Boggs St
Lexington, GA 30648-2321
Phone (706) 743-0006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200127001542 | GA | Part B Supplier - Clinic/Group Practice | 5991130635 |
Receives reassigned benefits from 2 practitioners Practice locations: Lexington, GA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2171254 | Oglethorpe Ear Nose and Throat, LLC | Certificate of waiver | Aug 27, 2027 |
National Provider Directory
National Provider DirectoryLocations
219 W Boggs St
Lexington, GA 30648
Phone (706) 743-0006
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564617600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1654646400000",
"number": "1164076600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "219 W BOGGS ST",
"city": "LEXINGTON",
"state": "GA",
"postal_code": "306482321",
"telephone_number": "706-743-0006",
"fax_number": "706-740-6073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "219 WEST BOGGS STREET",
"city": "LEXINGTON",
"state": "GA",
"postal_code": "30648",
"telephone_number": "706-743-0006",
"fax_number": "706-740-6073"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OGLETHORPE EAR, NOSE & THROAT, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-08-01",
"last_updated": "2022-06-08",
"certification_date": "2022-06-08",
"status": "A",
"authorized_official_last_name": "PITTS",
"authorized_official_first_name": "MATT",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "706-743-0006"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Otolaryngology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lexington, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.