The Hospital Authority of Miller County
Organization Active NPI Rural Health Clinic/Center · Colquitt, GA
NPI 1528110103 · NPPES record last updated Nov 3, 2021
Key facts
- NPI
- 1528110103
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 100118 (GA)
- Legal business name
- THE HOSPITAL AUTHORITY OF MILLER COUNTY
- Practice address
- 208 North Cuthbert St
Colquitt, GA 39837 - Phone
- (229) 758-3304
- Fax
- (229) 758-6622
- NPI assigned
- Jan 17, 2007
- Organization subpart
- No
Authorized official
- Name
- Robin A Rau
- Title
- Ceo
- Phone
- (229) 758-5954
Owned or controlled facilities with NPI records 6
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 10
Related certifications (CCN) 1
Practitioners 31
-
Stephanie Davis Phillips, NP-C
-
Dave Stewart, M.D.
-
William Swofford, MD
-
Karen Nicole Trawick, CRNA
-
Clint J Anthony, NP
-
Elnaz Balashi, MD
-
Stamey Seleste Cook, FNP-C
-
Anand Dave, MD
-
Ketan Desai, MD
-
Charles J Fetner, CRNA
-
Samuel Jason Fletcher, FNP-BC
-
Stephanie Cook McLain, APRN, FNP-C
-
Jennifer Ross, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0666859 | Miller County Medical Center | Certificate of waiver | Mar 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Rural health clinic certification: CCN 113997
- Legal name
- THE HOSPITAL AUTHORITY OF MILLER COUNTY
- Doing business as
- MILLER COUNTY MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 21, 1994
- Last certification
- Mar 1, 2022
- Ownership / control type
- 2B
- Organization structure
- Other · Non-profit
- Enrollment address
- 208N Cuthbert St
Colquitt, GA 39837-3517 - Related CCNs
- 111305
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Robin a Rau |
Corporate Officer |
Jan 1, 2008 | |
| W-2 Managing Employee |
Sep 17, 2012 |
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| Miller County Hospital |
Hospital | 5% Or Greater Direct Ownership Interest | Feb 24, 2014 |
| Miller County Hospital |
Hospital | 5% Or Greater Direct Ownership Interest | Feb 24, 2014 |
| Miller Nursing Home |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Oct 26, 1966 |
| Calhoun Nursing Home |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2013 |
| Miller Home Health |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Dec 16, 2020 |
| Robert E Jennings Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Feb 4, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040414000857 | GA | Part B Supplier - Clinic/Group Practice | 0244224947 |
Receives reassigned benefits from 29 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Colquitt, GA |
| O20110104000304 | GA | Part a Provider - Rural Health Clinic | 0244224947 | Practice locations: Colquitt, GA |
National Provider Directory
Locations
208 N Cuthbert St
Colquitt, GA 39837
Phone (229) 758-3304
Interoperability endpoints
- stephaniephillips@hamc.cernerdirect.com
- royreardon@hamc.cernerdirect.com
- markeshagroomes@hamc.cernerdirect.com
- garrettbennett@hamc.cernerdirect.com
- courtneyclanton@hamc.cernerdirect.com
- jessicadunnigan@hamc.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 100118 | GA | Yes |
Addresses
Primary practice location
208 North Cuthbert St
Colquitt, GA 39837
Mailing address
209 North Cuthbert St
PO Box 7
Colquitt, GA 39837
Phone (229) 758-3304
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000014821 | Medicaid | GA |
Other names
- Miller County Medical Center
Other providers in Colquitt, GA
- The Hospital Authority of Miller County
- The Hospital Authority of Miller County
- The Hospital Authority of Miller County
- The Hospital Authority of Miller County
- The Hospital Authority of Miller County
- The Hospital Authority of Miller County
- The Hospital Authority of Miller County
- The Hospital Authority of Miller County
- The Hospital Authority of Miller County
- The Hospital Authority of Miller County
All providers in Colquitt, GA · Rural Health Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.