NPIMap

Organization Active NPI

Tift Regional Health System Inc

Doing business as Tift Regional Wound Care Center

  • Clinic/Center
  • Tifton, GA
National Provider Identifier
1306244090
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
031888 Issued in GA
Legal business name
TIFT REGIONAL HEALTH SYSTEM INC
Doing business as
Tift Regional Wound Care Center
Practice address
907 18TH St E
Suite 140
Tifton, GA 31794-3643
Phone
(229) 353-4325
NPI assigned
Dec 11, 2014
Last updated
Jun 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2022

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

Authorized official

Name
Christopher Dorman
Title
President/Ceo
Phone
(229) 353-6104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 031888 GA Primary

Addresses

Primary practice location

907 18TH St E
Suite 140
Tifton, GA 31794-3643

Mailing address

PO Box 2650
Tifton, GA 31793-2650
Phone (229) 353-3422

Other names 1

  • Tift Regional Wound Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200217002409 GA Part B Supplier - Clinic/Group Practice 2062745169 Receives reassigned benefits from 389 practitioners
33 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tifton, GA; Adel, GA

Other NPIs on the same Medicare enrollment 23

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

View all 23

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
11D2179660Tift Regional Wound Care907 East 18TH Street Suite 140, Tifton, GA 31794Certificate of waiverFeb 26, 2028

National Provider Directory

National Provider Directory
Tax ID family
Tift Regional Health System Inc19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1418256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656028800000",
    "number": "1306244090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2650",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317932650",
            "telephone_number": "229-353-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 18TH ST E",
            "address_2": "SUITE 140",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943643",
            "telephone_number": "229-353-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIFT REGIONAL HEALTH SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-11",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A",
        "authorized_official_last_name": "DORMAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "229-353-6104"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "031888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tift Regional Wound Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tift Regional Wound Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tifton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; 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.