Lassina Will Koidima, AGACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

RN220878 Issued in GA

Practice address

1635 Pondside Dr
Statesboro, GA 30458-3777

Phone

(912) 507-9077

NPI assigned

Jun 21, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of South Alabama College of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Statesboro Hma Physician Management LLCGroup PAC ID 8820196058, 23 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• East Georgia Regional Medical Center Hospital, Statesboro, GA, CCN 110075

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Statesboro Hma Physician Management LLC

  • Hospitalist Physician
  • Statesboro, GA
  • NPI 1558412023

  Acute Care

  Medicare reassignment Care Compare group NPD
• Cogent Healthcare of Georgia PC

  • Internal Medicine Physician
  • Macon, GA
  • NPI 1609827823
  Medicare reassignment NPD
• Effingham Hospital, Inc.

  • Critical Access Hospital
  • Springfield, GA
  • NPI 1811962756
  Medicare reassignment NPD
• Effingham Hospital, Inc.

  • Otolaryngology Physician
  • Springfield, GA
  • NPI 1881588028
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• East Georgia Regional Medical Center, LLC

  • General Acute Care Hospital
  • Statesboro, GA
  • NPI 1265486278
  Care Compare affiliation

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

{
    "created_epoch": "1561075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1710548771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 PONDSIDE DR",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304583777",
            "telephone_number": "912-507-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 PONDSIDE DR",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304583777",
            "telephone_number": "912-507-9077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1499 Fair Rd",
            "address_purpose": "LOCATION",
            "city": "Statesboro",
            "state": "GA",
            "postal_code": "304581683",
            "country_code": "US",
            "telephone_number": "912-486-1000",
            "fax_number": "912-486-1488",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOIDIMA",
        "first_name": "LASSINA",
        "middle_name": "WILL",
        "credential": "AGACNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-21",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "RN220878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy O Kitching, DC
• Kenneth J Kitching, DC
• Lillie Knight
• Damon Owen Knighten, PT, DPT
• Hailey Knowles
• Suzanne M Konz, PH.D ATC CSCS
• Luke Daniel Krautter, M.D.
• Tiffany Kreun, ACNP
• Kriss Enterprises, Inc
• Joseph P Kropp, PHD

• Acute Care Nurse Practitioner in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Acute Care Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.