NPIMap

Organization Active NPI

Brooks County Hospital

  • Critical Access Hospital
  • Quitman, GA
National Provider Identifier
1306890942
Registry record updated Mar 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
014-428 Issued in GA
Legal business name
BROOKS COUNTY HOSPITAL
Practice address
903 N Court St
Quitman, GA 31643-1315
Phone
(229) 263-4171
NPI assigned
May 19, 2006
Last updated
Mar 8, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2017

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

Authorized official

Name
Mr. Gregory S. Hembree
Title
Cfo
Phone
(229) 228-2880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 014-428 GA Primary

Addresses

Primary practice location

903 N Court St
Quitman, GA 31643-1315

Mailing address

920 Cairo Rd
Thomasville, GA 31792-4255
Phone (229) 228-8800

Other identifiers 3

IdentifierTypeStateIssuer
111332A000000OtherGATRAILBLAZER
000000239AMedicaidGA
000020OtherGABC/BS GA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, TX, CO, DC, MI, KY, MA, CA, PR, LA11 enrollments

Enrollment records 11

Enrollment IDStateProvider typePAC IDDetails
O20040316000884 GA Part B Supplier - Clinic/Group Practice 1557279049 Receives reassigned benefits from 48 practitioners
Practice locations: Marietta, GA; Smyrna, GA; Savannah, GA; Richmond Hill, GA; Quitman, GA; Peachtree City, GA; Newnan, GA; Macon, GA…
O20230202002375 GA Part A Provider - Critical Access Hospital 1557279049 1 other NPI on this enrollment
Practice locations: Quitman, GA
O20250909003273 TX Part B Supplier - Clinic/Group Practice 1557279049 Receives reassigned benefits from 2 practitioners
Practice locations: Beaumont, TX; North Richland Hills, TX
O20250910000722 CO Part B Supplier - Clinic/Group Practice 1557279049 Receives reassigned benefits from 2 practitioners
Practice locations: Denver, CO; Longmont, CO
O20250910001494 DC Part B Supplier - Clinic/Group Practice 1557279049 Receives reassigned benefits from 1 practitioner
Practice locations: Vienna, VA
O20250911003571 MI Part B Supplier - Clinic/Group Practice 1557279049 Receives reassigned benefits from 1 practitioner
Practice locations: Troy, MI
O20251007003038 KY Part B Supplier - Clinic/Group Practice 1557279049 Receives reassigned benefits from 1 practitioner
Practice locations: Louisville, KY
O20251203003972 MA Part B Supplier - Clinic/Group Practice 1557279049 Receives reassigned benefits from 1 practitioner
Practice locations: Arlington, MA
O20251211003100 CA Part B Supplier - Clinic/Group Practice 1557279049 Receives reassigned benefits from 1 practitioner
Practice locations: Carmel, CA
O20260312001825 PR Part B Supplier - Clinic/Group Practice 1557279049 Receives reassigned benefits from 1 practitioner
Practice locations: Carolina, PR
O20260527004085 LA Part B Supplier - Clinic/Group Practice 1557279049 Receives reassigned benefits from 1 practitioner
Practice locations: Belle Chasse, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306890942. Details of each certification follow.

Hospital certification: CCN 111332

Legal name
BROOKS COUNTY HOSPITAL
Doing business as
ARCHBOLD BROOKS
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
May 1, 2003
Last certification
Oct 10, 2024
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
903 N Court St
Quitman, GA 31643-1315
Main/Primary Hospital Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Archbold BrooksCCN 111332 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

4375 Ave Isla Verde
Apt 11H
Carolina, PR 00979

Ownership & related parties

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Andrea Kidd Collins Individual Corporate DirectorBoard Member Feb 25, 2025
Craig R Wentworth Individual Corporate DirectorBoard Member Jul 1, 2021
Patricia L Barrett Individual W-2 Managing EmployeeDirector Sep 1, 2006
Carla Pearce Individual Corporate OfficerChief Accounting Officer Oct 1, 2021
W-2 Managing EmployeeChief Acct Officer Jul 1, 2021
Brian J Szwarc Individual Corporate DirectorBoard Member Oct 1, 2021
Sina E. Griffith Individual Corporate DirectorBoard Member Oct 1, 2021
Jason Odell Burnette Individual Corporate DirectorBoard Member Mar 1, 2025
Josh David Simmons Individual Corporate DirectorBoard Member Jan 1, 2023
John D Archbold Memorial Hospital Inc Organization, Thomasville, GA Non-profit Operational/Managerial Control Jun 11, 1987
Henry a. Stone Individual Corporate DirectorBoard Member Oct 1, 2021
Timothy Eric Ward Individual Corporate DirectorBoard Member Feb 25, 2025
Karen L Bramblett Individual Corporate DirectorBoard Member Jan 1, 2023
Darcy M Craven Individual Corporate DirectorBoard Member Jul 1, 2021
Joe S Carnline Individual Corporate DirectorBoard Member Jan 1, 2023
Ashley T. Cason Individual Corporate DirectorBoard Member Jan 1, 2023
Christopher L Daniels Individual Corporate DirectorBoard Member Mar 1, 2025
Loren Rials Individual Corporate OfficerSr VP & Cfo Aug 18, 2025
Marvin E. Dawson Individual Corporate DirectorBoard Member Jan 1, 2023
William G Hamil Individual Corporate DirectorBoard Member Jan 28, 2023
Jami Porter Individual Corporate DirectorBoard Member Jan 1, 2023
Gregory Hembree Individual Corporate DirectorSVP/Cfo Dec 15, 2016
W-2 Managing EmployeeSVP/Cfo Dec 15, 2016
Jacquelyn V. Santoro Individual Corporate DirectorBoard Member Jan 1, 2023
Jason M Nesmith Individual Corporate DirectorBoard Member Oct 1, 2021

Owners & managing parties with NPI records 13

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 13

Facilities with the same owner 11

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 67

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 67

Affiliated clinicians 53

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488931200000",
    "number": "1306890942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 CAIRO RD",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317924255",
            "telephone_number": "229-228-8800",
            "fax_number": "229-228-8892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 N COURT ST",
            "city": "QUITMAN",
            "state": "GA",
            "postal_code": "316431315",
            "telephone_number": "229-263-4171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKS COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2017-03-08",
        "status": "A",
        "authorized_official_last_name": "HEMBREE",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-228-2880",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "GA",
            "license": "014-428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAILBLAZER",
            "identifier": "111332A000000",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000239A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS GA",
            "identifier": "000020",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quitman, GA

Sources for this page

Verify at the official NPI Registry.