Brian Douglas Siddall, M.D.
Individual provider Active NPI General Practice Physician · MC Rae, GA
NPI 1205029352 · NPPES record last updated Oct 29, 2018
Key facts
- NPI
- 1205029352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 023227 (GA)
- Practice address
- 280 E Willow Creek LN
MC Rae, GA 31055-5128 - Phone
- (478) 864-3448
- Fax
- (478) 864-1288
- NPI assigned
- Aug 22, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 21
Hospital & facility affiliations 6
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- General Practice
- Education
- Other, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Community Health Care Systems, Inc.
Practice addresses (Care Compare)
2251 W Elm St
Wrightsville, GA 31096-2017
Phone (478) 864-2600
Hospital & facility affiliations
- Adoration Home Health
- Amedisys Home Health
- Georgia Hospice Care
- Dodge County Hospital
- Fairview Park Hospital
- McRae Manor Nursing Home
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| McRae Manor Nursing Home |
Skilled nursing facility | Contracted Managing Employee | Jul 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040712001333 | GA | Practitioner - General Practice |
8325026644 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023227 | GA | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Care Systems, Inc. | Current | Accepting new patients | |
| Community Health Care Systems Inc, | Current |
Accepting new patients | |
| Community Health Care Systems, Inc | Current |
Accepting new patients | |
| Community Health Care Systems,Inc. | Past | Accepting new patients | |
| McRae Emergency Services, LLC | Past | Accepting new patients | |
| Pine Leaf Investment Inc. | Past | Accepting new patients | |
| PHG McRae LLC | Past | Accepting new patients |
Locations
280 E Willow Creek Ln
Mc Rae Helena, GA 31055
Phone (229) 868-0017
2251 W Elm St
Wrightsville, GA 31096
Phone (478) 864-2600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 023227 | GA | Yes |
Addresses
Primary practice location
280 E Willow Creek LN
MC Rae, GA 31055-5128
Mailing address
PO Box 371
2251 West Elm Street
Wrightsville, GA 31096-0371
Phone (478) 864-3448
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23227 | Other | GA | STATE LICENSE |
Other providers in MC Rae, GA
- Biff Rutherford
- Ryals Drug Store
- S & P Drug Co
- Salvat Internal Medicine, LLC
- Brena Johnson Siddall
- Katherine Danelle Smith
- Smith'S Pharmacy of McRae, L.L.C.
- Waylon Spires
- Heather J Spivey
- Tiffany Waters Spurlin
All providers in MC Rae, GA · General Practice Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.