NPIMap

Organization Active NPI

Premise Health of Georgia Medical, P.C.

  • Family Medicine Physician
  • Savannah, GA
National Provider Identifier
1407910169
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PREMISE HEALTH OF GEORGIA MEDICAL, P.C.
Practice address
836 East 65TH Street, 4 Medical Arts
Savannah, GA 31405-4491
Phone
(912) 351-0057
Fax
(912) 351-0074
NPI assigned
Dec 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Jon Leizman, M.D.
Title
President
Phone
(216) 479-9603

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

836 East 65TH Street, 4 Medical Arts
Savannah, GA 31405-4491

Mailing address

16906 Collection Center Dr
Chicago, IL 60693-0169
Phone (877) 865-9013

Other identifiers 1

IdentifierTypeStateIssuer
8892OtherGAGROUP BCBS NUMBER

Other names 1

  • Employees' Family Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041209000829 GA Part B Supplier - Clinic/Group Practice 3274599345 Receives reassigned benefits from 13 practitioners
5 other NPIs on this enrollment
Practice locations: Baldwin, GA; Carrollton, GA; Gainesville, GA; Smyrna, GA; Tyrone, GA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1407910169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16906 COLLECTION CENTER DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606930169",
            "telephone_number": "877-865-9013",
            "fax_number": "217-709-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 EAST 65TH STREET, 4 MEDICAL ARTS",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314054491",
            "telephone_number": "912-351-0057",
            "fax_number": "912-351-0074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF GEORGIA MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9603",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BCBS NUMBER",
            "identifier": "8892",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Employees' Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Employees' Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Savannah, GA

Sources for this page

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