NPIMap

Organization Active NPI

Jenkins County Hosptial LLC

Doing business as Optim Surgical Associates - Jenkins

  • Surgery Physician
  • Millen, GA
National Provider Identifier
1386954394
Registry record updated Jul 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
JENKINS COUNTY HOSPTIAL LLC
Doing business as
Optim Surgical Associates - Jenkins
Practice address
960 College Ave
Millen, GA 30442-1634
Phone
(478) 982-1560
Fax
(478) 982-2478
NPI assigned
Oct 12, 2010
Last updated
Jul 24, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2015

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

Authorized official

Name
Mr. Robert Guenthner
Title
Secretary of Jenkins County Hospita
Phone
(312) 627-8247

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X GA Primary

Addresses

Primary practice location

960 College Ave
Millen, GA 30442-1634

Mailing address

210 E Derenne Ave
Savannah, GA 31405-6736
Phone (912) 644-5300

Other names 1

  • Optim Surgical Associates - Jenkins Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110126000836 GA Part B Supplier - Clinic/Group Practice 0143419820 Receives reassigned benefits from 5 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Millen, GA

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1286841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437696000000",
    "number": "1386954394",
    "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": "912-644-5260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 COLLEGE AVE",
            "city": "MILLEN",
            "state": "GA",
            "postal_code": "304421634",
            "telephone_number": "478-982-1560",
            "fax_number": "478-982-2478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENKINS COUNTY HOSPTIAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-12",
        "last_updated": "2015-07-24",
        "status": "A",
        "authorized_official_last_name": "GUENTHNER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "SECRETARY OF JENKINS COUNTY HOSPITA",
        "authorized_official_telephone_number": "312-627-8247",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optim Surgical Associates - Jenkins",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Millen, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; 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.