NPIMap

Organization Active NPI

Tift Regional Health System Inc

  • School Nurse Practitioner
  • Tifton, GA
National Provider Identifier
1508428442
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Nurse PractitionerTaxonomy code 363LS0200X
Legal business name
TIFT REGIONAL HEALTH SYSTEM INC
Practice address
1464 Carpenter Road S
Tifton, GA 31793
Phone
(229) 353-2227
Fax
(229) 388-9515
NPI assigned
Jul 1, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2022

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

Authorized official

Name
Christopher Dorman
Title
President/Ceo
Phone
(229) 353-6104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LS0200X Primary

Addresses

Primary practice location

1464 Carpenter Road S
Tifton, GA 31793

Mailing address

PO Box 2650
Tifton, GA 31793-2650
Phone (229) 353-3422

Other practice location 1

700 8th St W
Tifton, GA 31794-3803
Phone (229) 353-3767

Other names 1

  • Southwell School Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200217002409 GA Part B Supplier - Clinic/Group Practice 2062745169 Receives reassigned benefits from 389 practitioners
33 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tifton, GA; Adel, GA

National Provider Directory

National Provider Directory
Tax ID family
Tift Regional Health System Inc19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Other NPIs on the same Medicare enrollment 23

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

View all 23

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656028800000",
    "number": "1508428442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2650",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317932650",
            "telephone_number": "229-353-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1464 CARPENTER ROAD S",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "31793",
            "telephone_number": "229-353-2227",
            "fax_number": "229-388-9515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 8th St W",
            "address_purpose": "LOCATION",
            "city": "Tifton",
            "state": "GA",
            "postal_code": "317943803",
            "country_code": "US",
            "telephone_number": "229-353-3767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIFT REGIONAL HEALTH SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-01",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A",
        "authorized_official_last_name": "DORMAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "229-353-6104"
    },
    "taxonomies": [
        {
            "code": "363LS0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, School",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwell School Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwell School Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tifton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; 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.