NPIMap

Organization Active NPI

Hospice Satilla of Memorial Hospital Inc

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Waycross, GA
National Provider Identifier
1508434408
Registry record updated Jun 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
HOSPICE SATILLA OF MEMORIAL HOSPITAL INC
Practice address
808 Evergreen Way
Waycross, GA 31501-7102
Phone
(912) 285-2340
Fax
(912) 283-0200
NPI assigned
Jun 16, 2021
Organization subpart
Yes
Parent organization
HOSPICE SATILLA OF MEMORIAL HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 24, 2021

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

Authorized official

Name
Debra Thrift Golden
Title
Executive Director
Phone
(912) 285-2340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RH0002X Primary

Addresses

Primary practice location

808 Evergreen Way
Waycross, GA 31501-7102

Mailing address

808 Evergreen Way
Waycross, GA 31501-7102
Phone (912) 285-2340

Other names 1

  • Satilla Palliative Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210817002401 GA Part B Supplier - Clinic/Group Practice 7416975677 Receives reassigned benefits from 7 practitioners
Practice locations: Waycross, GA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Satilla Palliative Care2 organizations share this tax ID, including this one
Part of
Satilla Palliative Care

Other organizations with this tax ID 1

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

Locations

811 Beacon St
Waycross, GA 31501
Phone (912) 285-2340

808 Evergreen Way
Waycross, GA 31501
Phone (912) 285-2340

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

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": "1623801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624492800000",
    "number": "1508434408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 EVERGREEN WAY",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315017102",
            "telephone_number": "912-285-2340",
            "fax_number": "912-283-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 EVERGREEN WAY",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315017102",
            "telephone_number": "912-285-2340",
            "fax_number": "912-283-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE SATILLA OF MEMORIAL HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOSPICE SATILLA OF MEMORIAL HOSPITAL INC",
        "enumeration_date": "2021-06-16",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A",
        "authorized_official_last_name": "GOLDEN",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "THRIFT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "912-285-2340"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Satilla Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waycross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; 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.