Individual provider Active NPI

Thomas Richard Bair, MD

  • Family Medicine Physician
  • Fairfax, SC
National Provider Identifier
1669566501
Registry record updated Nov 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
54544 Issued in GA
Practice address
1787 Allendale Fairfax Hwy
Fairfax, SC 29827-9133
Phone
(803) 632-3311
Fax
(803) 632-9815
NPI assigned
Oct 3, 2006
Last updated
Nov 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 054544 GA
Emergency Medicine Physician 207P00000X 23245 SC
Family Medicine Physician 207Q00000X 54544 GA Primary

Addresses

Primary practice location

1787 Allendale Fairfax Hwy
Fairfax, SC 29827-9133

Mailing address

PO Box 218
Fairfax, SC 29827-0218
Phone (803) 632-3311

Other identifiers 1

IdentifierTypeStateIssuer
710752940AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040827001035 GA Practitioner - Emergency Medicine 0143295600 Reassigns benefits to 1 organization
I20090805000732 SC Practitioner - Emergency Medicine 0143295600 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
54544GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coffee Emergency Group LLC Emergency Medicine CurrentSince Jan 1, 2019 Accepting new patients
Allendale County Hospital Board Current Accepting new patients

Locations

1101 Ocilla Rd
Douglas, GA 31533
Phone (912) 383-5641

200 Corporate Blvd
Ste 201
Lafayette, LA 70508

1787 Allendale Fairfax Hwy
Fairfax, SC 29827
Phone (803) 632-3311

Interoperability endpoints

  • Direct secure messaging: thomas.bair.1@31541.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1669566501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 218",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "298270218",
            "telephone_number": "803-632-3311",
            "fax_number": "803-632-9815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1787 ALLENDALE FAIRFAX HWY",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "298279133",
            "telephone_number": "803-632-3311",
            "fax_number": "803-632-9815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAIR",
        "first_name": "THOMAS",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "054544",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "23245",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "54544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "710752940A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, SC

Sources for this page

Verify at the official NPI Registry.