Organization Active NPI

Oglethorpe Ear, Nose & Throat, LLC

  • Otolaryngology Physician
  • Lexington, GA
National Provider Identifier
1164076600
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
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

Updated by the provider on Jun 8, 2022

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)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 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 IDStateProvider typePAC IDDetails
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 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
11D2171254Oglethorpe Ear Nose and Throat, LLC219 W Boggs Street, Lexington, GA 30648Certificate of waiverAug 27, 2027

National Provider Directory

National Provider Directory

Locations

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.

Verify at the official NPI Registry.