NPIMap

Organization Active NPI

Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Brunswick, GA
National Provider Identifier
1487047726
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
OPTIM ORTHOPEDICS, LLC
Practice address
1111 Glynco Pkwy Ste 30a
Brunswick, GA 31525-7930
Phone
(912) 342-7112
Fax
(844) 788-1866
NPI assigned
Mar 11, 2015
Organization subpart
Yes
Parent organization
OPTIM ORTHOPEDICS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Mike Butler
Title
Ceo
Phone
(912) 644-5300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

1111 Glynco Pkwy Ste 30a
Brunswick, GA 31525-7930

Mailing address

210 E Derenne Ave
Attn.: Provider Enrollment
Savannah, GA 31405-6736
Phone (912) 644-5300

Other names 1

  • Optim Orthopedics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150429001342 GA Part B Supplier - Clinic/Group Practice 9931427002 Receives reassigned benefits from 144 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brunswick, GA; Vidalia, GA; Statesboro, GA; Savannah, GA; Rincon, GA; Richmond Hill, GA; Metter, GA; Jesup, GA…
O20240510000533 GA DME Supplier - Physician - Orthopedic/Orthopedic Surgery 9931427002 Practice locations: Brunswick, GA

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 30

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

View all 30

National Provider Directory

National Provider Directory
Tax ID family
Optim Orthopedics LLC13 organizations share this tax ID, including this one
Part of
Optim Orthopedics LLC

Other organizations with this tax ID 12

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

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1426032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1487047726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E DERENNE AVE",
            "address_2": "ATTN.: PROVIDER ENROLLMENT",
            "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": "1111 GLYNCO PKWY STE 30A",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315257930",
            "telephone_number": "912-342-7112",
            "fax_number": "844-788-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIM ORTHOPEDICS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPTIM ORTHOPEDICS, LLC",
        "enumeration_date": "2015-03-11",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-644-5300"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optim Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optim Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brunswick, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.