NPIMap

Organization Active NPI

Ocmulgee Physicians, LLC

  • Internal Medicine Physician
  • Macon, GA
National Provider Identifier
1629346416
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
032405 Issued in GA
Legal business name
OCMULGEE PHYSICIANS, LLC
Practice address
446 Poplar St
Suite B
Macon, GA 31201-3336
Phone
(478) 746-0097
Fax
(478) 742-4051
NPI assigned
Dec 7, 2011
Last updated
Jun 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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

Authorized official

Name
Alan D JusticeNPI 1114955572
Title
Owner
Phone
(478) 746-0097

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 032405 GA Primary

Addresses

Primary practice location

446 Poplar St
Suite B
Macon, GA 31201-3336

Mailing address

446 Poplar St
Suite B
Macon, GA 31201-3336
Phone (478) 746-0097

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120130000228 GA Part B Supplier - Clinic/Group Practice 5092972331 Receives reassigned benefits from 10 practitioners
Practice locations: Macon, GA

National Provider Directory

National Provider Directory

Locations

446 Poplar St
#B
Macon, GA 31201
Phone (478) 746-0097

Practitioners & affiliated clinicians

Practitioners 9

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": "1323216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1629346416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446 POPLAR ST",
            "address_2": "SUITE B",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013336",
            "telephone_number": "478-746-0097",
            "fax_number": "478-742-4051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "446 POPLAR ST",
            "address_2": "SUITE B",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013336",
            "telephone_number": "478-746-0097",
            "fax_number": "478-742-4051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCMULGEE PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-07",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-746-0097"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "032405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.