NPIMap

Individual provider Active NPI

Brian Douglas Siddall, M.D.

  • General Practice Physician
  • McRae, GA
National Provider Identifier
1205029352
Registry record updated Oct 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
023227 Issued in 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
Last updated
Oct 29, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 023227 GA Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040712001333 GA Practitioner - General PracticePractitioner - Emergency Medicine 8325026644 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2251 W Elm St
Wrightsville, GA 31096-2017
Phone (478) 864-2600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
023227GAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Care Systems, Inc CurrentSince Aug 5, 2014 Accepting new patients
Community Health Care Systems Inc, CurrentSince Aug 5, 2014 Accepting new patients
Community Health Care Systems, Inc. Current Accepting new patients
Pine Leaf Investment Inc. Past Accepting new patients
Community Health Care Systems,Inc. Past Accepting new patients
McRae Emergency Services, LLC 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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
McRae Manor Nursing HomeMC Rae Helena, GA, CCN 115494 Skilled nursing facility Contracted Managing Employee Jul 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • PHG McRae LLC

    dba McRae Manor Nursing Home

    • Skilled Nursing Facility
    • McRae, GA
    • NPI 1962251645

    Contracted Managing Employee

    CMS ownership

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540771200000",
    "number": "1205029352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 371",
            "address_2": "2251 WEST ELM STREET",
            "city": "WRIGHTSVILLE",
            "state": "GA",
            "postal_code": "310960371",
            "telephone_number": "478-864-3448",
            "fax_number": "478-864-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 E WILLOW CREEK LN",
            "city": "MC RAE",
            "state": "GA",
            "postal_code": "310555128",
            "telephone_number": "478-864-3448",
            "fax_number": "478-864-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDALL",
        "first_name": "BRIAN",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-22",
        "last_updated": "2018-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "023227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McRae, GA

Sources for this page

Verify at the official NPI Registry.