NPIMap

Organization Active NPI

Hospital Authority of Jeff Davis County Georgia

  • Specialist
  • Hazlehurst, GA
National Provider Identifier
1578334264
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
HOSPITAL AUTHORITY OF JEFF DAVIS COUNTY GEORGIA
Practice address
11 Cross St
Hazlehurst, GA 31539-6427
Phone
(912) 699-6570
NPI assigned
Jan 11, 2024
Last updated
Jan 11, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
HOSPITAL AUTHORITY OF JEFF DAVIS COUNTY GEORGIAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Authorized official

Name
Barry Bloom
Title
Administrator
Phone
(912) 375-7781

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

11 Cross St
Hazlehurst, GA 31539-6427

Mailing address

PO Box 1690
Hazlehurst, GA 31539-1690
Phone (912) 375-7781

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040504000404 GA Part B Supplier - Clinic/Group Practice 4981692472 Receives reassigned benefits from 30 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hazlehurst, GA; MC Rae Helena, GA

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Hospital Auth of Jeff D7 organizations share this tax ID, including this one
Part of
Hospital Auth of Jeff D

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1578334264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1690",
            "city": "HAZLEHURST",
            "state": "GA",
            "postal_code": "315391690",
            "telephone_number": "912-375-7781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 CROSS ST",
            "city": "HAZLEHURST",
            "state": "GA",
            "postal_code": "315396427",
            "telephone_number": "912-699-6570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF JEFF DAVIS COUNTY GEORGIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOSPITAL AUTHORITY OF JEFF DAVIS COUNTY GEORGIA",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "BARRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "912-375-7781"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazlehurst, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; 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.