Active NPI
Optim Orthopedics LLC
- Orthopaedic Surgery Physician
- Macon, GA
National Provider Identifier
1376042796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- Legal business name
- OPTIM ORTHOPEDICS LLC
- Practice address
- 121 N Crest Blvd
Macon, GA 31210-1845 - Phone
- (478) 841-9333
- Fax
- (912) 644-5241
- NPI assigned
- Feb 12, 2018
- Organization subpart
- Yes
- Parent organization
- OPTIM ORTHOPEDICS LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mike Butler
- Title
- Ceo
- Phone
- (912) 644-5300
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | Primary |
Addresses
Primary practice location
121 N Crest Blvd
Macon, GA 31210-1845
Mailing address
210 E Derenne Ave
Savannah, GA 31405-6736
Phone (912) 644-5300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150429001342 | GA | Part B Supplier - Clinic/Group Practice | 9931427002 |
Receives reassigned benefits from 144 practitioners 30 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Brunswick, GA; Vidalia, GA; Statesboro, GA; Savannah, GA; Rincon, GA; Richmond Hill, GA; Metter, GA; Jesup, GA… |
Other NPIs on the same Medicare enrollment 30
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Optim Orthopedics LLC
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physical Therapist
- Statesboro, GA
- NPI 1477338663
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518393600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1547769600000",
"number": "1376042796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 E DERENNE AVE",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314056736",
"telephone_number": "912-644-5300",
"fax_number": "912-644-5241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 N CREST BLVD",
"city": "MACON",
"state": "GA",
"postal_code": "312101845",
"telephone_number": "478-841-9333",
"fax_number": "912-644-5241"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OPTIM ORTHOPEDICS LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "OPTIM ORTHOPEDICS LLC",
"enumeration_date": "2018-02-12",
"last_updated": "2019-01-18",
"status": "A",
"authorized_official_last_name": "BUTLER",
"authorized_official_first_name": "MIKE",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "912-644-5300"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; 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.