NPIMap

Organization Active NPI

CCSG, Inc.

  • Cardiovascular Disease Physician
  • Thomasville, GA
National Provider Identifier
1295120145
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CCSG, INC.
Practice address
116 Mimosa Dr
Thomasville, GA 31792-6605
Phone
(229) 551-0083
NPI assigned
Mar 30, 2015
Last updated
Nov 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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

Authorized official

Name
Mr. Gregory Hembree
Title
Chief Financial Officer
Phone
(229) 228-2853

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

116 Mimosa Dr
Thomasville, GA 31792-6605

Mailing address

116 Mimosa Dr
Thomasville, GA 31792-6605
Phone (229) 551-0083

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150727002586 GA Part B Supplier - Clinic/Group Practice 6103130745 Receives reassigned benefits from 26 practitioners
Practice locations: Thomasville, GA; Bainbridge, GA; Quitman, GA; Moultrie, GA; Cairo, GA; Camilla, GA
O20170208002096 FL Part B Supplier - Clinic/Group Practice 6103130745 Receives reassigned benefits from 3 practitioners
Practice locations: Tallahassee, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2108686CCSG, Inc116 Mimosa Drive, Thomasville, GA 31792Certificate of waiverFeb 8, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1 Sweet Bay Ct
Ste C
Moultrie, GA 31768
Phone (229) 890-3569

115 31st Ave SE
Moultrie, GA 31768
Phone (229) 502-1020

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1427673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604361600000",
    "number": "1295120145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 MIMOSA DR",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926605",
            "telephone_number": "229-551-0083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 MIMOSA DR",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926605",
            "telephone_number": "229-551-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCSG, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-30",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A",
        "authorized_official_last_name": "HEMBREE",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "229-228-2853",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thomasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.