NPIMap

Organization Active NPI

Hospital Authority of Liberty County

Doing business as Liberty Regional Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Hinesville, GA
National Provider Identifier
1487817169
Registry record updated Feb 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
089101 Issued in GA
Legal business name
HOSPITAL AUTHORITY OF LIBERTY COUNTY
Doing business as
Liberty Regional Medical Center
Practice address
462 Elma G Miles Parkway
Hinesville, GA 31313-4000
Phone
(912) 369-9400
Fax
(912) 877-9438
NPI assigned
Jul 3, 2008
Last updated
Feb 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2022

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

Authorized official

Name
Mr. Michael S Hester
Title
Ceo
Phone
(912) 369-9400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 089101 GA Primary

Addresses

Primary practice location

462 Elma G Miles Parkway
Hinesville, GA 31313-4000

Mailing address

PO Box 919
Hinesville, GA 31310-0919
Phone (912) 369-9400

Other names 1

  • Liberty Regional 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
O20220908002060 GA Part A Provider - Critical Access Hospital 5799772190 Practice locations: Hinesville, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487817169. Details of each certification follow.

Hospital certification: CCN 11Z335

Legal name
HOSPITAL AUTHORITY OF LIBERTY COUNTY
Doing business as
LIBERTY REGIONAL MEDICAL CENTER
Organization structure
OtherNon-profit
Enrollment address
462 E G Miles Pkwy
Hinesville, GA 31313-4000
Main/Primary Hospital Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Derek Rozier Individual W-2 Managing EmployeeCfo Jan 1, 2015
James Rogers Individual Corporate OfficerVice Chairman Jan 1, 2009
James Thomas Individual Corporate OfficerTrustee Dec 1, 2003
Will Darsey Individual Corporate OfficerSecretary / Teasurer Jan 1, 2009
Hospital Authority of Liberty County Organization, Hinesville, GA Created for acquisition 5% Or Greater Direct Ownership Interest Dec 13, 2007
Hugh S Kroell Individual Corporate DirectorCeo Oct 15, 2008
W-2 Managing EmployeeCeo Oct 15, 2008
Reginald Pierce Individual Corporate Officer Nov 5, 2014
Bobby L Herrington Individual Corporate OfficerTrustee Dec 1, 2008
Brooke Horne Individual Corporate OfficerTrustee Jan 1, 2014

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Liberty Regional Medical CenterHinesville, GA, CCN 111335 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 5, 2014

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645142400000",
    "number": "1487817169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 919",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313100919",
            "telephone_number": "912-369-9400",
            "fax_number": "912-877-9438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "462 ELMA G MILES PARKWAY",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313134000",
            "telephone_number": "912-369-9400",
            "fax_number": "912-877-9438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF LIBERTY COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-03",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "HESTER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-369-9400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "GA",
            "license": "089101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Liberty Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hinesville, GA

Sources for this page

Verify at the official NPI Registry.