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Organization Active NPI

Crisp Regional Hospital, Inc

Doing business as Crisp Regional LTC Pharmacy

  • Long Term Care Pharmacy
  • Cordele, GA
National Provider Identifier
1679836142
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
CRISP REGIONAL HOSPITAL, INC
Doing business as
Crisp Regional LTC Pharmacy
Practice address
216 Hospital Dr
Cordele, GA 31015-3275
Phone
(229) 276-3372
Fax
(229) 276-3641
NPI assigned
Jun 20, 2012
Last updated
Jul 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Authorized official

Name
Whitney Hill Brown, PHARMD
Title
Director of Pharmacy
Phone
(229) 276-3386

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PHRE005310 GA
Long Term Care Pharmacy 3336L0003X NU Primary

Addresses

Primary practice location

216 Hospital Dr
Cordele, GA 31015-3275

Mailing address

902 N 7TH St
902 N 7TH Street
Cordele, GA 31015-3234
Phone (229) 276-3386

Other names 1

  • CRISP REGIONAL LTC PHARMACY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210330001903 GA Part B Supplier - Mass Immunization (Roster Biller Only) 5991616336 Practice locations: Cordele, GA

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Surgical Associates22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

108 E 4th Ave
Cordele, GA 31015
Phone (229) 276-2190

1302 N 5th Street Ext
Cordele, GA 31015
Phone (229) 273-2322

202 E 4th Ave
Cordele, GA 31015
Phone (229) 273-6282

404 E 4th Ave
Cordele, GA 31015
Phone (229) 273-4322

408 E 3rd Ave
Cordele, GA 31015
Phone (229) 271-2229

906 N 5th St
Ste F6
Cordele, GA 31015
Phone (229) 271-4690

2858 Pine St
Unadilla, GA 31091
Phone (478) 627-3263

135 Dogwood St SW
Warwick, GA 31796
Phone (229) 535-4567

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Crisp Regional HospitalCordele, GA, CCN 110104 Hospital Operational/Managerial Control (100%) Feb 1, 1996
Crisp Regional HospitalCordele, GA, CCN 11U104 Hospital Operational/Managerial Control (100%) Feb 1, 1996
Caresouth an Affiliate of Crisp Regional HospitalCordele, GA, CCN 117309 Home health agency 5% Or Greater Direct Ownership Interest Dec 14, 2007
Crisp Regional Convenient CareCordele, GA, CCN 118555 Rural health clinic Operational/Managerial Control May 1, 2012

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 119

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 119

NPI Registry JSON

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1679836142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 N 7TH ST",
            "address_2": "902 N 7TH STREET",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310153234",
            "telephone_number": "229-276-3386",
            "fax_number": "229-276-3387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 HOSPITAL DR",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310153275",
            "telephone_number": "229-276-3372",
            "fax_number": "229-276-3641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRISP REGIONAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "WHITNEY",
        "authorized_official_middle_name": "HILL",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "229-276-3386",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "PHRE005310",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRISP REGIONAL LTC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CRISP REGIONAL LTC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cordele, GA

Sources for this page

Verify at the official NPI Registry.