Charlton Memorial Hospital

Primary specialty

Critical Access HospitalTaxonomy code 282NC0060X

License

024106 Issued in GA

Legal business name

CHARLTON MEMORIAL HOSPITAL

Practice address

2449 Third St
Folkston, GA 31537-8919

Phone

(912) 496-2531

Fax

(912) 496-7766

NPI assigned

Aug 31, 2006

Last updated

Dec 7, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly Savage

Title

Cfo

Phone

(912) 496-2531

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710099098. Details of each certification follow.

• CCN 111315 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 111315

Legal name

CHARLTON MEMORIAL HOSPITAL

Certification status

Terminated Voluntary: merger or closure, Sep 23, 2013

Provider type (POS)

Hospital – Critical access hospital

Participating since

Mar 1, 2001

Last certification

Jun 10, 2010

Beds

25

Ownership / control type

Hospital district or authority

Facility address

2449 Third Street
Folkston, GA 31537

Subparts reporting this organization as parent 1

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

• Charlton Memorial Hospital

  dba Family Practice Clinic

  • Rural Health Clinic/Center
  • Folkston, GA
  • NPI 1760548002
  NPPES parent name

Practitioners 3

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.

• Ghislain Richard Perron, MD

  • Family Medicine Physician
  • Folkston, GA
  • NPI 1063413706
  NPD
• Robert Duaine Lott, MD, MPH

  • Emergency Medicine Physician
  • Folkston, GA
  • NPI 1700027364
  NPD (past)
• Dennis P Sorresso, M.D.

  • Sleep Medicine (Internal Medicine) Physician
  • Springfield, MA
  • NPI 1245283357
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323216000000",
    "number": "1710099098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "address_2": "2449 THIRD ST",
            "city": "FOLKSTON",
            "state": "GA",
            "postal_code": "315370188",
            "telephone_number": "912-496-2531",
            "fax_number": "912-496-7766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2449 THIRD ST",
            "city": "FOLKSTON",
            "state": "GA",
            "postal_code": "315378919",
            "telephone_number": "912-496-2531",
            "fax_number": "912-496-7766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLTON MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2011-12-07",
        "status": "A",
        "authorized_official_last_name": "SAVAGE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "912-496-2531"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "GA",
            "license": "024-106",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "GA",
            "license": "024106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010341100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000338A0",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcus Allen Bowen, NP
• Charlton County Board of Education
• Charlton County Board of Health
• Charlton County Commissioners
• Charlton CS
• Charlton Memorial Hospital (Family Practice Clinic)
• James Cutia, NP
• Miryam Bordow Daconceicao
• Will Cameron Duncan, PT
• Brian Jay Eddy, PHARMD

• Critical Access Hospital in Folkston, GA
• Providers in Folkston, GA by specialty
• Critical Access Hospital in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.