NPIMap

Organization Active NPI

Putnam General Hospital Authority

Doing business as Putnam General Hospital

  • Critical Access Hospital
  • Eatonton, GA
National Provider Identifier
1386670834
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
117-216 Issued in GA
Legal business name
PUTNAM GENERAL HOSPITAL AUTHORITY
Doing business as
Putnam General Hospital
Practice address
101 Lake Oconee Pkwy
Eatonton, GA 31024-6054
Phone
(706) 923-2002
Fax
(706) 485-2702
NPI assigned
Jun 25, 2006
Last updated
Jun 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Authorized official

Name
Anita Culberson
Title
Compliance Officer
Phone
(706) 923-2006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 117-216 GA Primary

Addresses

Primary practice location

101 Lake Oconee Pkwy
Eatonton, GA 31024-6054

Mailing address

101 Lake Oconee Pkwy
Eatonton, GA 31024-6054
Phone (706) 923-2002

Other identifiers 3

IdentifierTypeStateIssuer
0006210575OtherGAAETNA PROVIDER NUMBER
00001537AMedicaidGA
336OtherGABC/BS PROVIDER NUMBER

Other names 1

  • Putnam General Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040610001279 GA Part B Supplier - Clinic/Group Practice 4688657612 Receives reassigned benefits from 16 practitioners
Practice locations: Eatonton, GA
O20070628000459 GA Part A Provider - Critical Access Hospital 4688657612 Practice locations: Eatonton, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386670834. Details of each certification follow.

Hospital certification: CCN 111313

Legal name
PUTNAM GENERAL HOSPITAL AUTHORITY
Doing business as
PUTNAM GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 25, 2001
Last certification
Apr 4, 2013
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Incorporated
Mar 1, 1968 in GA
Enrollment address
101 Lake Oconee Pkwy
Eatonton, GA 31024-6054
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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Putnam General HospitalCCN 111313 · 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
Tax ID family
Putnam General Hospital Authority6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Brenda Jarrett Individual W-2 Managing Employee May 13, 2010
Putnam General Hospital Authority Organization, Eatonton, GA 5% Or Greater Direct Ownership Interest May 13, 2010
Operational/Managerial Control May 13, 2010
Anita Culberson Individual Corporate Director Mar 22, 2007
W-2 Managing Employee May 13, 2010
Operational/Managerial Control Jan 20, 2011
James Horton Individual Corporate Officer Jan 8, 2014
Darrell Oglesby Individual Corporate Director May 1, 2007
W-2 Managing Employee May 13, 2010

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 20

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 20

Affiliated clinicians 61

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

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1386670834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 LAKE OCONEE PKWY",
            "city": "EATONTON",
            "state": "GA",
            "postal_code": "310246054",
            "telephone_number": "706-923-2002",
            "fax_number": "706-485-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 LAKE OCONEE PKWY",
            "city": "EATONTON",
            "state": "GA",
            "postal_code": "310246054",
            "telephone_number": "706-923-2002",
            "fax_number": "706-485-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUTNAM GENERAL HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "CULBERSON",
        "authorized_official_first_name": "ANITA",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "706-923-2006"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "GA",
            "license": "117-216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "0006210575",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00001537A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER NUMBER",
            "identifier": "336",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Putnam General Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eatonton, GA

Sources for this page

Verify at the official NPI Registry.