NPIMap

Individual provider Active NPI

Cianna Pender

  • Surgery Physician
  • Thomasville, GA
National Provider Identifier
1376832261
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
76648 Issued in GA
Practice address
100 Mimosa Dr
Thomasville, GA 31792-6676
Phone
(229) 226-8881
Fax
(229) 584-5964
NPI assigned
Mar 31, 2011
Last updated
Aug 5, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 76648 GA Primary

Addresses

Primary practice location

100 Mimosa Dr
Thomasville, GA 31792-6676

Mailing address

100 Mimosa Dr
Thomasville, GA 31792-6676
Phone (229) 226-8881

Other identifiers 1

IdentifierTypeStateIssuer
2151193MedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cianna.pender.p8@direct.archbold.nextgenshare.com

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
I20161011000874 GA Practitioner - General Surgery 8628366499 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Archbold Medical Group, Inc.Group PAC ID 8123196383, 80 clinicians

Practice addresses (Care Compare)

100 Mimosa Dr
Thomasville, GA 31792-6676
Phone (229) 228-5500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair (minimally invasive)1-10
Mastectomy11
Melanoma (skin cancer) excision1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
76648GAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grady General Hospital CurrentSince Sep 8, 2018 Accepting new patients
John D Archbold Memorial Hospital Inc CurrentSince Aug 4, 2016 Accepting new patients
Brooks County Hospital CurrentSince Sep 8, 2018 Accepting new patients
Pathology Associates, P.C. Current Accepting new patients
Hospital Authority of Mitchell County CurrentSince Sep 8, 2018 Accepting new patients
Archbold Medical Group, Inc. Surgery CurrentSince Aug 4, 2016 Accepting new patients
Archbold Medical Group, Inc. CurrentSince Aug 4, 2016 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

1155 5th St SE
Cairo, GA 39828
Phone (229) 226-3060

90 E Stephens St
Camilla, GA 31730
Phone (229) 200-4950

1309 W Screven St
Quitman, GA 31643
Phone (229) 263-6992

903 N Court St
Quitman, GA 31643
Phone (229) 263-4531

100 Mimosa Dr
Thomasville, GA 31792
Phone (229) 226-9141

900 Cairo Rd
Thomasville, GA 31792
Phone (229) 227-5102

915 Gordon Ave
Thomasville, GA 31792
Phone (229) 228-8575

919 S Broad St
Thomasville, GA 31792
Phone (229) 584-5400

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

947 S Broad St
Thomasville, GA 31792
Phone (229) 228-3731

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/66097e3b-7cef-4b96-acca-38bfaae85903/

Organizations & group practices 8

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 3

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": "1301529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1376832261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MIMOSA DR",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926676",
            "telephone_number": "229-226-8881",
            "fax_number": "229-584-5964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MIMOSA DR",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926676",
            "telephone_number": "229-226-8881",
            "fax_number": "229-584-5964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDER",
        "first_name": "CIANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-31",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "76648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2151193",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cianna.pender.p8@direct.archbold.nextgenshare.com",
            "affiliation": "N",
            "address_1": "100 Mimosa Dr",
            "city": "Thomasville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "317926676",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Thomasville, GA

Sources for this page

Verify at the official NPI Registry.