NPIMap

Organization Active NPI

Hospital Authority of Jeff Davis County Georgia

Doing business as Telfair Medical Group

  • Multi-Specialty Clinic/Center
  • McRae Helena, GA
National Provider Identifier
1619693454
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
HOSPITAL AUTHORITY OF JEFF DAVIS COUNTY GEORGIA
Doing business as
Telfair Medical Group
Practice address
134 Eighth St
MC Rae Helena, GA 31037-3846
Phone
(229) 868-8203
NPI assigned
Oct 13, 2022
Last updated
Oct 13, 2022By 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 Oct 13, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

134 Eighth St
MC Rae Helena, GA 31037-3846

Mailing address

134 Eighth St
MC Rae Helena, GA 31037-3846

Other names 1

  • Telfair Medical Group Doing business as

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.

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
11D2273336Telfair Medical Group134 8TH Street, Helena, GA 31037Certificate of waiverDec 11, 2026

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.

Locations

134 Eighth St
Mc Rae Helena, GA 31037
Phone (229) 868-8203

Practitioners & affiliated clinicians

Practitioners 2

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": "1665619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1619693454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 EIGHTH ST",
            "city": "MC RAE HELENA",
            "state": "GA",
            "postal_code": "310373846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 EIGHTH ST",
            "city": "MC RAE HELENA",
            "state": "GA",
            "postal_code": "310373846",
            "telephone_number": "229-868-8203"
        }
    ],
    "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": "2022-10-13",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "BARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-375-7781"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Telfair Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McRae Helena, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.