NPIMap

Organization Active NPI

St. Mary's Medical Group, Inc.

  • Pediatrics Physician
  • Watkinsville, GA
National Provider Identifier
1588047138
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ST. MARY'S MEDICAL GROUP, INC.
Practice address
1020 Jamestown Blvd
BLDG 200
Watkinsville, GA 30677-4131
Phone
(706) 769-0005
Fax
(706) 769-0403
NPI assigned
Jul 1, 2015
Last updated
Nov 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Authorized official

Name
Brittainy Horne
Title
President
Phone
(706) 389-3940

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1020 Jamestown Blvd
BLDG 200
Watkinsville, GA 30677-4131

Mailing address

PO Box 48089
Athens, GA 30604-8089
Phone (706) 389-3740

Other names 1

  • Hometown Pediatrics Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080616000388 GA Part B Supplier - Clinic/Group Practice 7113098393 Receives reassigned benefits from 126 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Athens, GA; Bogart, GA; Greensboro, GA; Lavonia, GA; Monroe, GA; Watkinsville, GA

Other NPIs on the same Medicare enrollment 28

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

View all 28

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2099553Hometown Pediatrics1020 Jamestown Blvd BLDG 200, Watkinsville, GA 30677Certificate of waiverJul 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
St Mary's Medical Group Inc16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

1021 Jamestown Blvd
Ste 215
Watkinsville, GA 30677
Phone (706) 389-2273

Practitioners & affiliated clinicians

Practitioners 8

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": "1435708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1588047138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 48089",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306048089",
            "telephone_number": "706-389-3740",
            "fax_number": "706-389-3951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 JAMESTOWN BLVD",
            "address_2": "BLDG 200",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306774131",
            "telephone_number": "706-769-0005",
            "fax_number": "706-769-0403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-01",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "HORNE",
        "authorized_official_first_name": "BRITTAINY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-389-3940"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hometown Pediatrics",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Hometown Pediatrics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Watkinsville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.