NPIMap

Organization Active NPI

St. Joseph'S Vascular Group, LLC

  • Vascular Surgery Physician
  • Savannah, GA
National Provider Identifier
1164829883
Registry record updated Apr 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
ST. JOSEPH'S VASCULAR GROUP, LLC
Practice address
11909 McAuley Drive
Suite 100 A2
Savannah, GA 31419
Phone
(912) 954-8331
Fax
(912) 352-9782
NPI assigned
Nov 24, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2020

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

Authorized official

Name
Paul P. Hunchey
Title
President/Ceo
Phone
(912) 819-6901

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

11909 McAuley Drive
Suite 100 A2
Savannah, GA 31419

Mailing address

836 E. 65TH Street
Suite 22
Savannah, GA 31405
Phone (912) 819-7878

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150326001687 GA Part B Supplier - Clinic/Group Practice 6305163650 Receives reassigned benefits from 8 practitioners
Practice locations: Baxley, GA; Hinesville, GA; Jesup, GA; Pooler, GA; Savannah, GA; Statesboro, GA
O20151002000845 SC Part B Supplier - Clinic/Group Practice 6305163650 Receives reassigned benefits from 2 practitioners
Practice locations: Bluffton, SC

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

111 Colonial Way
Ste 3
Jesup, GA 31545
Phone (912) 427-8365

11909 McAuley Dr
Ste 100A2
Savannah, GA 31419
Phone (912) 925-3767

5102 Paulsen St
Bldg 2
Savannah, GA 31405
Phone (912) 954-8331

16741 Highway 67
Ste A
Statesboro, GA 30458
Phone (912) 623-2391

10 Oak Forest Rd
Ste B
Bluffton, SC 29910
Phone (912) 303-0891

Practitioners & affiliated clinicians

Practitioners 9

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": "1416787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587686400000",
    "number": "1164829883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 E. 65TH STREET",
            "address_2": "SUITE 22",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31405",
            "telephone_number": "912-819-7878",
            "fax_number": "912-819-3320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11909 MCAULEY DRIVE",
            "address_2": "SUITE 100 A2",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31419",
            "telephone_number": "912-954-8331",
            "fax_number": "912-352-9782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH'S VASCULAR GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-24",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A",
        "authorized_official_last_name": "HUNCHEY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "912-819-6901"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2020; 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.