NPIMap

Organization Active NPI

Tift Regional Health System Inc

Doing business as Georgia Sports Medicine

  • Orthopaedic Surgery Physician
  • Tifton, GA
National Provider Identifier
1376920488
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
015420 Issued in GA
Legal business name
TIFT REGIONAL HEALTH SYSTEM INC
Doing business as
Georgia Sports Medicine
Practice address
2227 US Highway 41 N
Tifton, GA 31794-2749
Phone
(229) 386-5222
Fax
(229) 386-0900
NPI assigned
Apr 28, 2015
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
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X 015420 GA Primary

Addresses

Primary practice location

2227 US Highway 41 N
Tifton, GA 31794-2749

Mailing address

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

Other practice location 1

2922 N Oak St Ste C
Valdosta, GA 31602-1885
Phone (229) 386-5222

Other names 1

  • Georgia Sports Medicine 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

National Provider Directory

National Provider Directory
Tax ID family
Southwell Pharmacy21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Interoperability endpoints

  • Direct secure messaging: david.banks@trhs.cernerdirect.com
  • Direct secure messaging: edward.hellman@trhs.cernerdirect.com
  • Direct secure messaging: james.scott@trhs.cernerdirect.com
  • Direct secure messaging: william.smith@trhs.cernerdirect.com

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1430179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656028800000",
    "number": "1376920488",
    "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": "2227 US HIGHWAY 41 N",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317942749",
            "telephone_number": "229-386-5222",
            "fax_number": "229-386-0900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2922 N Oak St Ste C",
            "address_purpose": "LOCATION",
            "city": "Valdosta",
            "state": "GA",
            "postal_code": "316021885",
            "country_code": "US",
            "telephone_number": "229-386-5222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIFT REGIONAL HEALTH SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-28",
        "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": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "GA",
            "license": "015420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgia Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Georgia Sports Medicine",
            "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.