NPIMap

Organization Active NPI

Mercymed of Columbus Inc

  • Internal Medicine Physician
  • Columbus, GA
National Provider Identifier
1639450877
Registry record updated Oct 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
58922 Issued in GA
Legal business name
MERCYMED OF COLUMBUS INC
Practice address
3702 2ND Avenue
Columbus, GA 31904
Phone
(706) 507-9209
NPI assigned
Sep 1, 2011
Last updated
Oct 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2023

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

Authorized official

Name
Mr. Tony Nguyen
Title
Chief Operations Officer
Phone
(706) 507-9209

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 58922 GA Primary
Pediatrics Physician 208000000X 58922 GA

Addresses

Primary practice location

3702 2ND Avenue
Columbus, GA 31904

Mailing address

3702 2ND Ave
Columbus, GA 31904-7408
Phone (706) 507-9209

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120709000380 GA Part B Supplier - Clinic/Group Practice 3779748280 Receives reassigned benefits from 22 practitioners
Practice locations: Columbus, GA

National Provider Directory

National Provider Directory

Locations

3679 Steam Mill Rd
Columbus, GA 31906
Phone (706) 507-4687

Practitioners & affiliated clinicians

Practitioners 43

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.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1314835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697673600000",
    "number": "1639450877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 2ND AVE",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319047408",
            "telephone_number": "706-507-9209",
            "fax_number": "706-507-9249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 2ND AVENUE",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "31904",
            "telephone_number": "706-507-9209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCYMED OF COLUMBUS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-01",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "706-507-9209",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "58922",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "58922",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; 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.