NPIMap

Individual provider Active NPI

Bennett P Hogan, M.D.

  • Family Medicine Physician
  • Valdosta, GA
National Provider Identifier
1205891397
Registry record updated Jun 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
050024 Issued in GA
Practice address
117 W Northside Dr
Valdosta, GA 31602-1700
Phone
(229) 333-0616
Fax
(229) 333-0647
NPI assigned
Apr 20, 2006
Last updated
Jun 27, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 050024 GA Primary

Addresses

Primary practice location

117 W Northside Dr
Valdosta, GA 31602-1700

Mailing address

117 W Northside Dr
Valdosta, GA 31602-1700
Phone (229) 333-0616

Other identifiers 1

IdentifierTypeStateIssuer
000906177AMedicaidGA

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
I20050217000468 GA Practitioner - Family Practice 2769434794 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Mercer University School of Medicine, 1998
Medicare assignment
May accept Medicare assignment
Group practices
SGMC Physician Network IncGroup PAC ID 4082036843, 128 clinicians
Apogee Medical Group GeorgiaGroup PAC ID 4587676945, 122 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

2501 N Patterson St
Valdosta, GA 31602-1735
Phone (229) 433-1000

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
050024GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Authority of Valdosta and Lowndes County Georgia Current Accepting new patients
SGMC Affiliated Services LLC Current Accepting new patients
Bennett P Hogan MD PC Family Medicine CurrentSince Jun 1, 2001 Accepting new patients
South Georgia Medical Center Inc CurrentSince Sep 11, 2024 Accepting new patients
South Georgia Medical Center Inc CurrentSince Sep 11, 2024 Accepting new patients
Hospital Authority of Valdosta and Lowndes County, Georgia CurrentSince Nov 15, 2011 Accepting new patients
SGMC Physician Network Inc Family Medicine CurrentSince Oct 1, 2024 Accepting new patients
Hospital Authority of Valdosta and Lowndes County, Georgia CurrentSince Nov 15, 2011 Accepting new patients
Apogee Medical Group Georgia Inc CurrentSince Jul 1, 2024 Accepting new patients
Emergency Medicine South LLC Past Accepting new patients

Locations

101 W Northside Dr
Bldg G
Valdosta, GA 31602
Phone (229) 333-0616

117 W Northside Dr
Valdosta, GA 31602
Phone (229) 242-6061

2501 N Ashley St
Valdosta, GA 31602
Phone (229) 224-7368

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

410 Northside Dr
Valdosta, GA 31602
Phone (229) 242-7368

4280 N Valdosta Rd
Valdosta, GA 31602
Phone (229) 433-7350

Organizations & group practices 12

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 9

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": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340755200000",
    "number": "1205891397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 W NORTHSIDE DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021700",
            "telephone_number": "229-333-0616",
            "fax_number": "229-333-0647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 W NORTHSIDE DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021700",
            "telephone_number": "229-333-0616",
            "fax_number": "229-333-0647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOGAN",
        "first_name": "BENNETT",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2012-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "050024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000906177A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.