Penny D Booth, CFNP
Individual provider Active NPI Family Nurse Practitioner · Tifton, GA
NPI 1710078423 · NPPES record last updated Mar 30, 2021
Key facts
- NPI
- 1710078423
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN202921 (GA)
- Practice address
- 901 18TH St E
Tifton, GA 31794-3648 - Phone
- (229) 382-7120
- NPI assigned
- Sep 27, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 18
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tift Regional Health System Inc
Practice addresses (Care Compare)
1007 Greenfield Dr
Tifton, GA 31794-3795
Phone (229) 382-9733
104 8TH St W
Unit a
Tifton, GA 31794-3985
Phone (229) 391-4426
1111 20TH St E
Tifton, GA 31794-3689
Phone (229) 391-4030
1493 Kennedy Rd
Suite a
Tifton, GA 31794-4178
Phone (229) 391-4130
1499 Kennedy Rd
Suite C
Tifton, GA 31794-4177
Phone (229) 238-3034
1623 Madison Ave
Tifton, GA 31794-3757
Phone (229) 353-7720
1641 Madison Ave
Tifton, GA 31794-3757
Phone (229) 535-2285
1803 Old Ocilla Rd
Tifton, GA 31794-1617
Phone (229) 386-2181
1815 Old Ocilla Rd
Tifton, GA 31794-1617
Phone (229) 391-5353
2225 US Hwy 41 N
Tifton, GA 31794-2749
Phone (229) 391-4100
2227 US Hwy 41 N
Tifton, GA 31794-2749
Phone (229) 353-6188
39 Kent Rd
Tifton, GA 31794-1697
4468 Union Rd
Tifton, GA 31794-8331
Phone (229) 353-6320
700 8TH St W
Tifton, GA 31794-3803
Phone (229) 353-3767
901 18TH St E
Tifton, GA 31794-3648
Phone (229) 382-7120
907 18TH St E
Tifton, GA 31794-3684
Phone (229) 391-3600
907 18TH St E
Suite 140
Tifton, GA 31794-3643
Phone (229) 353-4325
Hospital & facility affiliations
- Tift Regional Medical Center
- Southwell Medical, a Campus of TRMC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090812000284 | GA | Practitioner - Nurse Practitioner | 6002831096 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tift Regional Health System Inc | Current | Accepting new patients | |
| Tift Regional Health System Inc | Current |
Accepting new patients | |
| Theoria Medical | Current |
Accepting new patients | |
| Tift Regional Health System Inc | Current |
Accepting new patients | |
| Tift Regional Health System Inc | Current |
Accepting new patients | |
| Tift Regional Health System Inc. | Current | Accepting new patients | |
| Bradley J Richardson MD Ed D Inc | Past | Accepting new patients |
Locations
505 Coliseum Dr
Macon, GA 31217
Phone (478) 743-8687
2227 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-6188
2735 Central Ave S
Tifton, GA 31794
Phone (229) 388-5690
2225 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-3422
907 18th St E
Ste 400
Tifton, GA 31794
907 18th St E
Ste 150
Tifton, GA 31794
Phone (229) 353-3422
901 18th St E
Tifton, GA 31794
Phone (229) 353-6208
7300 Lester Rd
Union City, GA 30291
Phone (770) 703-2604
Interoperability endpoints
- penny.booth@trhs.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN202921 | GA | Yes |
Addresses
Primary practice location
901 18TH St E
Tifton, GA 31794-3648
Mailing address
907 18TH St E Ste 400
Tifton, GA 31794-3684
Phone (229) 353-3422
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000270634 | Medicaid | OH | |
| 3810004243 | Medicaid | WV | |
| 2933277 | Medicaid | OH |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | penny.booth@trhs.cernerdirect.com |
Other providers in Tifton, GA
- Garrett Blalock
- Kathryn Blevins
- Bloom Chiropractic, LLC
- David Q Bobo
- Rachael Boney-King
- Andrea Boutwell
- Anna Bowen
- Jessica Ann Boyd
- Lauren Monk Boyett
- Parviz Brahman
All providers in Tifton, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.