NPIMap

Organization Active NPI

Cardiovascular Associates of Eastern Georgia

  • Specialist
  • Statesboro, GA
National Provider Identifier
1518902147
Registry record updated Feb 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
58253 Issued in GA
Legal business name
CARDIOVASCULAR ASSOCIATES OF EASTERN GEORGIA
Practice address
1497 Fair Rd
Suite 305
Statesboro, GA 30458-0822
Phone
(912) 681-2273
NPI assigned
Jun 18, 2006
Last updated
Feb 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2018

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

Authorized official

Name
Ajay JainNPI 1104853787
Title
President
Phone
(912) 681-2273

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 58253 GA Primary

Addresses

Primary practice location

1497 Fair Rd
Suite 305
Statesboro, GA 30458-0822

Mailing address

1497 Fair Rd
Suite 305
Statesboro, GA 30458-0822

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061023000386 GA Part B Supplier - Clinic/Group Practice 9335146083 Receives reassigned benefits from 1 practitioner
Practice locations: Metter, GA; Statesboro, GA; Swainsboro, GA; Vidalia, GA

National Provider Directory

National Provider Directory

Locations

163 E Tollison St
Baxley, GA 31513
Phone (912) 367-9847

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518480000000",
    "number": "1518902147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1497 FAIR RD",
            "address_2": "SUITE 305",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1497 FAIR RD",
            "address_2": "SUITE 305",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580822",
            "telephone_number": "912-681-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIOVASCULAR ASSOCIATES OF EASTERN GEORGIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2018-02-13",
        "status": "A",
        "authorized_official_last_name": "JAIN",
        "authorized_official_first_name": "AJAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-681-2273"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "58253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2018; 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.