NPIMap

Individual provider Active NPI

Jill G Bryant, MD

  • Internal Medicine Physician
  • Waycross, GA
National Provider Identifier
1306820741
Registry record updated Nov 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
043375 Issued in GA
Practice address
711 Knight Ave
Waycross, GA 31501-1943
Phone
(912) 283-9423
Fax
(912) 283-8204
NPI assigned
Nov 30, 2005
Last updated
Nov 17, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 043375 GA Primary

Addresses

Primary practice location

711 Knight Ave
Waycross, GA 31501-1943

Mailing address

711 Knight Ave
Waycross, GA 31501-1943
Phone (912) 283-9423

Other identifiers 3

IdentifierTypeStateIssuer
000755125DMedicaidGA
1306820741OtherGAMEDICARE NPI
CG6045OtherGARAILROAD MEDICARE GROUP ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100422000810 GA Practitioner - Internal Medicine 6305973371 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of South Alabama College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Internal Medicine Associates of Waycross P.C.Group PAC ID 0749276004, 5 clinicians

Practice addresses (Care Compare)

711 Knight Ave
Waycross, GA 31501-1943
Phone (912) 283-9423

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
043375GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System in Waycross, Inc. CurrentSince Jul 1, 1997 Accepting new patients
Integrated Regional Laboratories Pathology Services, LLC Current Accepting new patients
Baptist Village, Inc. Past Accepting new patients

Locations

410 Darling Ave
Waycross, GA 31501
Phone (912) 283-3030

Interoperability endpoints

  • Direct secure messaging: jill.bryant@gwim.eclinicaldirectplus.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1306820741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 KNIGHT AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315011943",
            "telephone_number": "912-283-9423",
            "fax_number": "912-283-8204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 KNIGHT AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315011943",
            "telephone_number": "912-283-9423",
            "fax_number": "912-283-8204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYANT",
        "first_name": "JILL",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-30",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "043375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000755125D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NPI",
            "identifier": "1306820741",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP ID",
            "identifier": "CG6045",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

Verify at the official NPI Registry.