NPIMap

Organization Active NPI

Phoebe Physiatry

  • Physical Medicine & Rehabilitation Physician
  • Albany, GA
National Provider Identifier
1295055861
Registry record updated Jun 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
064173 Issued in GA
Legal business name
PHOEBE PHYSIATRY
Practice address
425 W 3Rd Ave
105
Albany, GA 31701-1941
Phone
(229) 312-5080
Fax
(229) 312-5085
NPI assigned
Jun 7, 2010
Last updated
Jun 7, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
PHOEBE PHYSICIAN GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 7, 2010

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

Authorized official

Name
Robert Lagesse
Title
Sr VP Phys Practices
Phone
(229) 312-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 064173 GA Primary

Addresses

Primary practice location

425 W 3Rd Ave
105
Albany, GA 31701-1941

Mailing address

425 W 3Rd Ave
105
Albany, GA 31701-1941
Phone (229) 312-5080

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090121000583 GA Part B Supplier - Clinic/Group Practice 8426112350 Receives reassigned benefits from 1,136 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Phoebe Family Medicinecoffee County26 organizations share this tax ID, including this one
Part of
Phoebe Family Medicinecoffee County

Other organizations with this tax ID 25

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

View all 25

Locations

2002 Palmyra Rd
Ste 201
Albany, GA 31701
Phone (229) 312-5802

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1275868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275868800000",
    "number": "1295055861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W 3RD AVE",
            "address_2": "105",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011941",
            "telephone_number": "229-312-5080",
            "fax_number": "229-312-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W 3RD AVE",
            "address_2": "105",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011941",
            "telephone_number": "229-312-5080",
            "fax_number": "229-312-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOEBE PHYSIATRY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOEBE PHYSICIAN GROUP INC",
        "enumeration_date": "2010-06-07",
        "last_updated": "2010-06-07",
        "status": "A",
        "authorized_official_last_name": "LAGESSE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "SR VP PHYS PRACTICES",
        "authorized_official_telephone_number": "229-312-1000"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "GA",
            "license": "064173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2010; 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.