NPIMap

Organization Active NPI

Crisp Regional Hospital, Inc

Doing business as Crisp Regional Nursing & Rehabilitation Center

  • Skilled Nursing Facility
  • Cordele, GA
National Provider Identifier
1396711099
Registry record updated Sep 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
040446 Issued in GA
Legal business name
CRISP REGIONAL HOSPITAL, INC
Doing business as
Crisp Regional Nursing & Rehabilitation Center
Practice address
902 Blackshear Rd
Cordele, GA 31015
Phone
(229) 271-9686
Fax
(229) 271-9689
NPI assigned
Feb 23, 2006
Last updated
Sep 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2018

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

Authorized official

Name
Lynn Renee Bearden
Title
Revenue Integrity Director
Phone
(229) 276-3146

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 040446 GA Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

902 Blackshear Rd
Cordele, GA 31015

Mailing address

902 Blackshear Rd
Cordele, GA 31015-3665
Phone (229) 271-9686

Other identifiers 1

IdentifierTypeStateIssuer
000274128AMedicaidGA

Other names 1

  • Crisp Regional Nursing & Rehabilitation Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090609000657 GA Part A Provider - Skilled Nursing Facility 5991616336 Practice locations: Cordele, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396711099. Details of each certification follow.

Skilled nursing facility certification: CCN 115568

Legal name
CRISP REGIONAL HOSPITAL INC
Doing business as
CRISP REGIONAL NURSING AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 1, 1994
Last certification
Feb 20, 2025
Beds
143
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Crisp Regional Hospital
Organization structure
CorporationNon-profit
Incorporated
Oct 21, 1996 in GA
Enrollment address
902 Blackshear Rd
Cordele, GA 31015-3665
Nursing home name
CRISP REGIONAL NSG & REHAB CTR

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Crisp Regional NSG & Rehab CtrCCN 115568 · All quality measures
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
May 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
14379.7 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0703117Crisp Regional Nursing & Rehab Center902 Blackshear Road, Cordele, GA 31015Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Surgical Associates22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

902 Blackshear Rd
Cordele, GA 31015
Phone (229) 271-9686

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Megan Logue Gibbs Individual Corporate DirectorAdministrator/NH Director Jan 1, 2025
Adp of the SNF May 30, 2025
David Kavtaradze Individual Corporate DirectorMedical Director Jan 1, 2025
Adp of the SNF May 30, 2025
Steven L. Gautney Individual Corporate OfficerCeo Mar 19, 2014 50%
Operational/Managerial Control Mar 19, 2014
Jessica Carter Individual Corporate OfficerCfo Mar 12, 2014
Operational/Managerial ControlCfo Mar 12, 2014

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Crisp Regional HospitalCordele, GA, CCN 110104 Hospital Operational/Managerial Control (100%) Feb 1, 1996
Crisp Regional HospitalCordele, GA, CCN 11U104 Hospital Operational/Managerial Control (100%) Feb 1, 1996
Caresouth an Affiliate of Crisp Regional HospitalCordele, GA, CCN 117309 Home health agency 5% Or Greater Direct Ownership Interest Dec 14, 2007
Crisp Regional Convenient CareCordele, GA, CCN 118555 Rural health clinic Operational/Managerial Control May 1, 2012

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536192000000",
    "number": "1396711099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 BLACKSHEAR RD",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310153665",
            "telephone_number": "229-271-9686",
            "fax_number": "229-271-9689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 BLACKSHEAR RD",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "31015",
            "telephone_number": "229-271-9686",
            "fax_number": "229-271-9689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRISP REGIONAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-23",
        "last_updated": "2018-09-06",
        "status": "A",
        "authorized_official_last_name": "BEARDEN",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "REVENUE INTEGRITY DIRECTOR",
        "authorized_official_telephone_number": "229-276-3146"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "040446",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000274128A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crisp Regional Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crisp Regional Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cordele, GA

Sources for this page

Verify at the official NPI Registry.