NPIMap

Organization Active NPI

Coffee Regional Medical Center, Inc

  • Anesthesiology Physician
  • Douglas, GA
National Provider Identifier
1437120946
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
COFFEE REGIONAL MEDICAL CENTER, INC
Practice address
1101 Ocilla Rd
Douglas, GA 31533-2207
Phone
(912) 384-1900
Fax
(912) 389-2105
NPI assigned
Feb 1, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mindy Lott
Title
Office Administrator
Phone
(912) 384-1900

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X GA
Anesthesiology Physician 207L00000X GA
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

1101 Ocilla Rd
Douglas, GA 31533-2207

Mailing address

PO Box 1287
Douglas, GA 31534-1287
Phone (912) 384-1900

Other names 1

  • Coffee Regional Medical Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040402000287 GA Part B Supplier - Clinic/Group Practice 4587656012 Receives reassigned benefits from 75 practitioners
4 other NPIs on this enrollment
Practice locations: Douglas, GA

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Coffee Regional Medical6 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.

Locations

1301 Peterson Ave N
Douglas, GA 31533

1301 Peterson Ave N
Ste B
Douglas, GA 31533

1301 Peterson Ave N
Ste B9
Douglas, GA 31533

1301 Peterson Ave S
Douglas, GA 31533

1050 Valdosta Hwy
Homerville, GA 31634
Phone (912) 383-6575

413 W Montgomery Xrds
Ste 602
Savannah, GA 31406
Phone (912) 691-5711

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Coffee Regional First CareDouglas, GA, CCN 113460 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 1996

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 81

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 81

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1437120946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1287",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315341287",
            "telephone_number": "912-384-1900",
            "fax_number": "912-389-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 OCILLA RD",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332207",
            "telephone_number": "912-384-1900",
            "fax_number": "912-389-2105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEE REGIONAL MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2022-07-21",
        "certification_date": "2021-12-16",
        "status": "A",
        "authorized_official_last_name": "LOTT",
        "authorized_official_first_name": "MINDY",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "912-384-1900"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coffee Regional Medical Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Coffee Regional Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Douglas, GA

Sources for this page

Verify at the official NPI Registry.