NPIMap

Individual provider Active NPI

Donald Anthony Selph Jr., MD FACP

  • Internal Medicine Physician
  • Eastman, GA
National Provider Identifier
1427163344
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
042117 Issued in GA
Practice address
911 Plaza Avenue
Suite D
Eastman, GA 31023
Phone
(478) 374-5544
Fax
(478) 374-0608
NPI assigned
Aug 20, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 042117 GA Primary

Addresses

Primary practice location

911 Plaza Avenue
Suite D
Eastman, GA 31023

Mailing address

911 Plaza Avenue
Suite D
Eastman, GA 31023
Phone (478) 374-5544

Other identifiers 1

IdentifierTypeStateIssuer
00795165AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090918000080 GA Practitioner - Internal Medicine 8921154857 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Mercer University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

911 Plaza Ave
Suite D
Eastman, GA 31023-6786
Phone (478) 374-5544

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions65
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
042117GAMDInternal Medicine Physician

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IDCEBA/Endpoint/IDCEBA

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Dodge County HospitalEastman, GA, CCN 110092 Hospital Corporate Director Aug 30, 2020
Dodge County HospitalEastman, GA, CCN 11U092 Hospital Corporate Director Aug 30, 2020
Dodge County HospitalEastman, GA, CCN 11S092 Hospital Corporate Director Oct 21, 2020

Owned or controlled facilities with NPI records 2

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

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427163344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 PLAZA AVENUE",
            "address_2": "SUITE D",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "31023",
            "telephone_number": "478-374-5544",
            "fax_number": "478-374-0608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 PLAZA AVENUE",
            "address_2": "SUITE D",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "31023",
            "telephone_number": "478-374-5544",
            "fax_number": "478-374-0608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELPH",
        "first_name": "DONALD",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MD FACP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "042117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00795165A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eastman, GA

Sources for this page

Verify at the official NPI Registry.