NPIMap

Organization Active NPI

SB Healthcare, LLC

Doing business as BridgeWay Palliative Care

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Lawrenceville, GA
National Provider Identifier
1235669045
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
License
067-0428-H Issued in GA
Legal business name
SB HEALTHCARE, LLC
Doing business as
BridgeWay Palliative Care
Practice address
2000 Riverside Pkwy Ste 107
Lawrenceville, GA 30043-5926
Phone
(678) 878-3215
Fax
(678) 878-3341
NPI assigned
Jun 14, 2017
Last updated
Apr 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SB HEALTHCARE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Authorized official

Name
Rick Cantrell
Title
Ceo
Phone
(205) 949-0400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X 067-0428-H GA Primary

Addresses

Primary practice location

2000 Riverside Pkwy Ste 107
Lawrenceville, GA 30043-5926

Mailing address

1395 South Marietta Pkwy
BLDG 400 Suite 102
Marietta, GA 30067-4440
Phone (678) 932-6302

Other names 1

  • BridgeWay Palliative Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170928000943 GA Part B Supplier - Clinic/Group Practice 3971800574 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawrenceville, GA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
SB Healthcare LLC2 organizations share this tax ID, including this one
Part of
SB Healthcare LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2000 Riverside Pkwy
Ste 107
Lawrenceville, GA 30043
Phone (678) 878-2950

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1235669045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 SOUTH MARIETTA PKWY",
            "address_2": "BLDG 400 SUITE 102",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300674440",
            "telephone_number": "678-932-6302",
            "fax_number": "678-402-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 RIVERSIDE PKWY STE 107",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435926",
            "telephone_number": "678-878-3215",
            "fax_number": "678-878-3341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SB HEALTHCARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SB HEALTHCARE, LLC",
        "enumeration_date": "2017-06-14",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "CANTRELL",
        "authorized_official_first_name": "RICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "205-949-0400"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "GA",
            "license": "067-0428-H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BridgeWay Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BridgeWay Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; 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.