NPIMap

Organization Active NPI

Jenkins County Hospital LLC

Doing business as Optim Internal Medicine - Millen

  • Internal Medicine Physician
  • Millen, GA
National Provider Identifier
1225333263
Registry record updated Dec 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
JENKINS COUNTY HOSPITAL LLC
Doing business as
Optim Internal Medicine - Millen
Practice address
532 College Ave
Millen, GA 30442-1602
Phone
(478) 982-4543
Fax
(478) 982-0150
NPI assigned
Jan 24, 2011
Last updated
Dec 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2011

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

Authorized official

Name
Michael W. Kleinpeter
Title
Ceo
Phone
(912) 644-5300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X GA Primary

Addresses

Primary practice location

532 College Ave
Millen, GA 30442-1602

Mailing address

210 E Derenne Ave
Savannah, GA 31405-6736
Phone (912) 644-5300

Other names 1

  • Optim Internal Medicine - Millen Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110126000836 GA Part B Supplier - Clinic/Group Practice 0143419820 Receives reassigned benefits from 5 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Millen, GA

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1295827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323043200000",
    "number": "1225333263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E DERENNE AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056736",
            "telephone_number": "912-644-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "532 COLLEGE AVE",
            "city": "MILLEN",
            "state": "GA",
            "postal_code": "304421602",
            "telephone_number": "478-982-4543",
            "fax_number": "478-982-0150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENKINS COUNTY HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-24",
        "last_updated": "2011-12-05",
        "status": "A",
        "authorized_official_last_name": "KLEINPETER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-644-5300"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optim Internal Medicine - Millen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Millen, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2011; 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.