NPIMap

Organization Active NPI

Hospital Authority of Washington County

  • Physical Therapy Clinic/Center
  • Sandersville, GA
National Provider Identifier
1528619491
Registry record updated Jun 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
HOSPITAL AUTHORITY OF WASHINGTON COUNTY
Practice address
610 Sparta Rd
Sandersville, GA 31082-1860
Phone
(478) 240-2000
NPI assigned
Sep 23, 2019
Last updated
Jun 3, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
HOSPITAL AUTHORITY OF WASHINGTON COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2020

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

Authorized official

Name
Owen Tyrell Kelly
Title
Provider Enrollment Coordinator
Phone
(478) 289-1192

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

610 Sparta Rd
Sandersville, GA 31082-1860

Mailing address

610 Sparta Rd
Sandersville, GA 31082-1860
Phone (478) 240-2000

Other identifiers 1

IdentifierTypeStateIssuer
000001218AMedicaidGA

Other names 1

  • Washington County Therapy Services Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040507000100 GA Part B Supplier - Clinic/Group Practice 4385552686 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sandersville, GA
O20110113000265 GA Part A Provider - Hospital 4385552686 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sandersville, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528619491. Details of each certification follow.

Hospital certification: CCN 110086

Legal name
HOSPITAL AUTHORITY OF WASHINGTON COUNTY
Doing business as
WASHINGTON COUNTY REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Oct 29, 1980
Last certification
Sep 6, 2024
Beds
56
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Incorporated
in GA
Enrollment address
610 Sparta Road
Sandersville, GA 31082-0636
Other Hospital Practice Location
Hospital subgroups
Acute care

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Washington County Regional Medical CenterCCN 110086 · All quality measures
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Anest Reg Med Ctr12 organizations share this tax ID, including this one
Part of
Anest Reg Med Ctr

Other organizations with this tax ID 11

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Pamela L Stewart Individual Corporate OfficerCeo Sep 28, 2023
Corporate DirectorBoard Member Sep 28, 2023
W-2 Managing EmployeeAd; Sep 28, 2023

Practitioners & affiliated clinicians

Practitioners 13

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 13

Affiliated clinicians 74

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

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1569196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591142400000",
    "number": "1528619491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 SPARTA RD",
            "city": "SANDERSVILLE",
            "state": "GA",
            "postal_code": "310821860",
            "telephone_number": "478-240-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 SPARTA RD",
            "city": "SANDERSVILLE",
            "state": "GA",
            "postal_code": "310821860",
            "telephone_number": "478-240-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF WASHINGTON COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOSPITAL AUTHORITY OF WASHINGTON COUNTY",
        "enumeration_date": "2019-09-23",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "OWEN",
        "authorized_official_middle_name": "TYRELL",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT COORDINATOR",
        "authorized_official_telephone_number": "478-289-1192"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000001218A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Washington County Therapy Services",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Washington County Therapy Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sandersville, GA

Sources for this page

Verify at the official NPI Registry.