NPIMap

Organization Active NPI

Family Care Group of Thomson, Inc

  • Family Medicine Physician
  • Thomson, GA
National Provider Identifier
1669660783
Registry record updated Mar 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
032327 Issued in GA
Legal business name
FAMILY CARE GROUP OF THOMSON, INC
Practice address
315 Fluker St
Thomson, GA 30824-2108
Phone
(706) 595-1090
Fax
(706) 595-6010
NPI assigned
Oct 15, 2007
Last updated
Mar 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2015

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

Authorized official

Name
Dr. Daryl C Wiley, MDNPI 1508859448
Title
President
Phone
(706) 595-1090

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 032327 GA Primary

Addresses

Primary practice location

315 Fluker St
Thomson, GA 30824-2108

Mailing address

315 Fluker St
Thomson, GA 30824-2108
Phone (706) 595-1090

Other identifiers 1

IdentifierTypeStateIssuer
GRP4411OtherGAMEDICARE GROUP NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050919000990 GA Part B Supplier - Clinic/Group Practice 9133153273 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
Practice locations: Thomson, GA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

315 Fluker St
Thomson, GA 30824
Phone (706) 595-1090

Interoperability endpoints

  • Direct secure messaging: daryl.wiley@gadirect.net
  • Direct secure messaging: daryl.wiley1@gadirect.net
  • Direct secure messaging: ekta.patel@gadirect.net
  • Direct secure messaging: james.sheppard@gadirect.net
  • Direct secure messaging: michael.mcdaniel@gadirect.net
  • Direct secure messaging: michael.stamper@gadirect.net

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 10

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": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425340800000",
    "number": "1669660783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 FLUKER ST",
            "city": "THOMSON",
            "state": "GA",
            "postal_code": "308242108",
            "telephone_number": "706-595-1090",
            "fax_number": "706-595-6010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 FLUKER ST",
            "city": "THOMSON",
            "state": "GA",
            "postal_code": "308242108",
            "telephone_number": "706-595-1090",
            "fax_number": "706-595-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE GROUP OF THOMSON, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2015-03-03",
        "status": "A",
        "authorized_official_last_name": "WILEY",
        "authorized_official_first_name": "DARYL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-595-1090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "032327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "GRP4411",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thomson, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; 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.