Hospice of South Georgia, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

HOSPICE OF SOUTH GEORGIA, INC.

Practice address

1625 Sunset Blvd
Jesup, GA 31545-7969

Phone

(912) 588-0080

Fax

(912) 588-0082

NPI assigned

Jul 2, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Toni Lynn Ray, RN

Title

Executive Director

Phone

(912) 588-0080

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487683223. Details of each certification follow.

• CCN 111574 Hospice · Active · Details

Hospice certification: CCN 111574

Legal name

HOSPICE OF SOUTH GEORGIA, INC.

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jul 7, 1999

Last certification

May 25, 2022

Ownership / control type

Non-Profit - Private

Organization structure

OtherNon-profit

Enrollment address

1625 Sunset Boulevard
Jesup, GA 31545

Listed as

Hospice of South Georgia, Inc.CCN 111574 · All quality measures

Ownership

For-Profit

Certified

Jul 7, 1999

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Hospice of South Georgia2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Hospice of South Georgia

  • Community Based Hospice Care Agency
  • Jesup, GA
  • NPI 1326571019
  NPD tax ID

All disclosed owners & managing parties 5

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

Practitioners 1

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.

• Lesleigh Dee Beard, FNP-BC, FNP-C

  • Family Nurse Practitioner
  • Jesup, GA
  • NPI 1043968316
  NPD

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1487683223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 SUNSET BLVD",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315457969",
            "telephone_number": "912-588-0080",
            "fax_number": "912-588-0082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SUNSET BLVD",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315457969",
            "telephone_number": "912-588-0080",
            "fax_number": "912-588-0082"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "42 Weaver St Unit B",
            "address_purpose": "LOCATION",
            "city": "Baxley",
            "state": "GA",
            "postal_code": "315130774",
            "country_code": "US",
            "telephone_number": "912-588-0080",
            "fax_number": "912-588-0082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HOSPICE OF SOUTH GEORGIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "TONI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "912-588-0080",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000840243A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Magan Ogden Hillyard, PHARMD
• Kristen Hinson
• Joseph Hires, DPT
• Deanna Renee Hodges, FNP
• Hospice of South Georgia
• Hospital Authority of Wayne County Georgia
• Hospital Authority of Wayne County Georgia
• Hospital Authority of Wayne County Georgia (Community Home Care)
• Hospital Authority of Wayne County, Georgia (Wayne Memorial Hospital)
• Hospital Authority of Wayne County, Georgia (wayne memorial hospital)

• Community Based Hospice Care Agency in Jesup, GA
• Providers in Jesup, GA by specialty
• Community Based Hospice Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.