NPIMap

Organization Active NPI

Elbert Memorial Hospital

  • Critical Access Hospital
  • Elberton, GA
National Provider Identifier
1669488250
Registry record updated Mar 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
ELBERT MEMORIAL HOSPITAL
Practice address
4 Medical Dr
Elberton, GA 30635-1830
Phone
(706) 283-3151
Fax
(706) 283-8609
NPI assigned
Aug 1, 2006
Last updated
Mar 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2020

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

Authorized official

Name
Brandy Scoggins
Title
Sr. Governmental Accountant
Phone
(706) 213-2516

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 52-46 GA
Critical Access Hospital 282NC0060X NU Primary

Addresses

Primary practice location

4 Medical Dr
Elberton, GA 30635-1830

Mailing address

4 Medical Dr
Elberton, GA 30635-1830
Phone (706) 283-3151

Other identifiers 2

IdentifierTypeStateIssuer
000000668SMedicaidGA
00000668AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20051206000245 GA Part B Supplier - Clinic/Group Practice 6800889841 Receives reassigned benefits from 6 practitioners
Practice locations: Elberton, GA
O20191014002843 GA Part A Provider - Critical Access Hospital 6800889841 Practice locations: Elberton, GA
O20200723000231 GA Part A Provider - Critical Access Hospital 6800889841 Practice locations: Elberton, GA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1669488250. Details of each certification follow.

Hospital certification: CCN 111337

Legal name
ELBERT MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 21, 2020
Last certification
Jan 21, 2020
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
OtherProprietary
Enrollment address
4 Medical Drive
Elberton, GA 30635-1830
Other Hospital Practice Location

Hospital certification: CCN 11Z337

Legal name
ELBERT MEMORIAL HOSPITAL
Organization structure
OtherProprietary
Enrollment address
4 Medical Dr
Elberton, GA 30635-1830
Hospital Swing-Bed Unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Elbert Memorial HospitalCCN 111337 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Locations

1420 Vernon Rd
Lagrange, GA 30240
Phone (706) 880-7411

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John Taylor Individual Corporate OfficerChief Executive Officer Jun 1, 2023 100%
W-2 Managing EmployeeChief Executive Officer Jun 1, 2023 100%
Glenn Poon Individual Corporate DirectorBoard Member Jan 1, 2017
Kam McClary Individual Corporate DirectorBoard Member Jan 1, 2016
Tom Steele Individual Corporate DirectorBoard Member, Vice Chair Jan 1, 2015
Leon Jourolmon Individual Corporate DirectorBoard Member, Treasurer Jan 1, 2015
Corporate DirectorBoard Member. Treasurer Jan 1, 2015
Scott Wilson Individual Corporate DirectorBoard Member Jan 1, 2019
Max Black Individual Corporate DirectorBoard Member, Secretary Jan 1, 2015
Kerry Trapnell Individual Corporate OfficerCeo Feb 1, 2018
Louis R Fernandez Individual Corporate DirectorBoard Member, Chief of Staff Jan 1, 2019
Steve Jenkins Individual Corporate DirectorBoard Member Jan 1, 2015
Daniel Graves Individual Corporate DirectorBoard Member, Chair Jan 1, 2014
Corporate DirectorDirector Aug 23, 1977
Gail Lavender Individual Corporate DirectorBoard Member Jan 1, 2014
Rachel McCall Individual Corporate DirectorBoard Member Jan 1, 2019
Brandy Scoggins Individual W-2 Managing Employee Aug 29, 2012

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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.

Affiliated clinicians 57

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584489600000",
    "number": "1669488250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MEDICAL DR",
            "city": "ELBERTON",
            "state": "GA",
            "postal_code": "306351830",
            "telephone_number": "706-283-3151",
            "fax_number": "706-283-8609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MEDICAL DR",
            "city": "ELBERTON",
            "state": "GA",
            "postal_code": "306351830",
            "telephone_number": "706-283-3151",
            "fax_number": "706-283-8609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELBERT MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A",
        "authorized_official_last_name": "SCOGGINS",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "SR. GOVERNMENTAL ACCOUNTANT",
        "authorized_official_telephone_number": "706-213-2516"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "GA",
            "license": "52-46",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000668S",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00000668A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elberton, GA

Sources for this page

Verify at the official NPI Registry.