Hospital Authority of the City of Bainbridge and Decatur County Georgi

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY GEORGI

Doing business as

Memorial Pediatrics

Practice address

603 Wheat Ave Ste 450
Bainbridge, GA 39819-4365

Phone

(229) 243-7707

NPI assigned

Sep 8, 2017

Last updated

Sep 8, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Karen Faircloth

Title

Cfo

Phone

(229) 246-8211

Specialties & licenses 1

Addresses

Other names 1

• Memorial Pediatrics Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629596853. Details of each certification follow.

• CCN 118581 Rural health clinic · Active · Name & address match · Details

Rural health clinic certification: CCN 118581

Legal name

MEMORIAL PEDIATRICS

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jul 29, 2021

Last certification

Jul 29, 2021

Ownership / control type

Non-profit – church related

Facility address

603 South Wheat Ave Suite 450
Bainbridge, GA 39819

Related CCNs

110132

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

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Hospital Authority of the City of Bainbridge and Decatur County

  • Skilled Nursing Facility
  • Bainbridge, GA
  • NPI 1881683324

  Member Of

  NPD member

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

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504828800000",
    "number": "1629596853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E SHOTWELL ST",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194256",
            "telephone_number": "229-243-1700",
            "fax_number": "229-246-9322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 WHEAT AVE STE 450",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194365",
            "telephone_number": "229-243-7707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY GEORGI",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-08",
        "last_updated": "2017-09-08",
        "status": "A",
        "authorized_official_last_name": "FAIRCLOTH",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-246-8211"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hospital Authority of the City of Bainbridge and Decatur County
• Hospital Authority of the City of Bainbridge and Decatur County
• Hospital Authority of the City of Bainbridge and Decatur County Georgi (Bainbridge Ophthalmology)
• Hospital Authority of the City of Bainbridge and Decatur County Georgi (J Sydney Cochran, PC)
• Hospital Authority of the City of Bainbridge and Decatur County Georgi (Magnolia Womens Center)
• Hospital Authority of the City of Bainbridge and Decatur County Georgi (Amelia Medical Plaza)
• Hospital Authority of the City of Bainbridge and Decatur County Georgi (Charles A. Walker, MD)
• Hoss Eyecare, P.C.
• Alicia Hurtt
• I See My Baby Inc.

• Multi-Specialty Clinic/Center in Bainbridge, GA
• Providers in Bainbridge, GA by specialty
• Multi-Specialty Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.