NPIMap

Organization Active NPI

Central Georgia Heart Institue, LLC

  • Cardiovascular Disease Physician
  • Warner Robins, GA
National Provider Identifier
1659313153
Registry record updated Nov 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
041593 Issued in GA
Legal business name
CENTRAL GEORGIA HEART INSTITUE, LLC
Practice address
1707 Watson Blvd Ste 200
Warner Robins, GA 31093-3607
Phone
(478) 929-8030
NPI assigned
Jun 11, 2006
Last updated
Nov 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2022

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

Authorized official

Name
Mrs. Misty Sanders
Title
Office Manger
Phone
(478) 293-4739

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 051049 GA
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 049348 GA
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 047951 GA
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X 041593 GA Primary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X 052467 GA
Sleep Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0012X 052467 GA

Addresses

Primary practice location

1707 Watson Blvd Ste 200
Warner Robins, GA 31093-3607

Mailing address

1707 Watson Blvd
Suite 200
Warner Robins, GA 31093-3606
Phone (478) 929-8030

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address misty@kazimd.com Direct
Direct Messaging Address mist@kazimd.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041122000706 GA Part B Supplier - Clinic/Group Practice 7315902087 Receives reassigned benefits from 3 practitioners
Practice locations: Warner Robins, GA

National Provider Directory

National Provider Directory

Locations

1707 Watson Blvd
Warner Robins, GA 31093
Phone (478) 929-8030

1707 Watson Blvd
Ste 200
Warner Robins, GA 31093
Phone (478) 929-8030

1743 Watson Blvd
Ste B
Warner Robins, GA 31093
Phone (478) 328-2122

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IBFHCA
  • Direct secure messaging: mist@kazimd.com
  • Direct secure messaging: misty@kazimd.com

Practitioners & affiliated clinicians

Practitioners 11

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": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669766400000",
    "number": "1659313153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 WATSON BLVD",
            "address_2": "SUITE 200",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310933606",
            "telephone_number": "478-929-8030",
            "fax_number": "478-929-8095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 WATSON BLVD STE 200",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310933607",
            "telephone_number": "478-929-8030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL GEORGIA HEART INSTITUE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "OFFICE MANGER",
        "authorized_official_telephone_number": "478-293-4739",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "051049",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "049348",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "047951",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "041593",
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "GA",
            "license": "052467",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "GA",
            "license": "052467",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "misty@kazimd.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1707 Watson Blvd",
            "city": "Warner Robins",
            "state": "GA",
            "country_code": "US",
            "postal_code": "310933606",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mist@kazimd.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1707 Watson Blvd Ste 200",
            "city": "Warner Robins",
            "state": "GA",
            "country_code": "US",
            "postal_code": "310933607",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Warner Robins, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.