NPIMap

Individual provider Active NPI

Cody Robert Ward, PA

  • Physician Assistant
  • Statesboro, GA
National Provider Identifier
1619493517
Registry record updated Aug 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1499 Fair Rd
Statesboro, GA 30458-1683
Phone
(912) 486-1510
NPI assigned
Aug 22, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1499 Fair Rd
Statesboro, GA 30458-1683

Mailing address

5629 Hwy 21 S
Rincon, GA 31326-9416
Phone (912) 295-2133

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180116001031 GA Practitioner - Physician Assistant 9436418621 Reassigns benefits to 7 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southland Optim Jenkins Emergency Medical Services, LLC CurrentSince Apr 10, 2018 Accepting new patients
Advanced Pediatric Specialists LLC Past Accepting new patients

Locations

931 E Winthrope Ave
Millen, GA 30442
Phone (478) 982-4221

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503360000000",
    "number": "1619493517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5629 HWY 21 S",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313269416",
            "telephone_number": "912-295-2133",
            "fax_number": "912-295-5924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1499 FAIR RD",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304581683",
            "telephone_number": "912-486-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARD",
        "first_name": "CODY",
        "middle_name": "ROBERT",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-22",
        "last_updated": "2017-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

Verify at the official NPI Registry.