NPIMap

Organization Active NPI

Affabilis LLC

Doing business as Columbus Specialty Hospital

  • Long Term Care Hospital
  • Columbus, GA
National Provider Identifier
1720084734
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
License
106-722 Issued in GA
Legal business name
AFFABILIS LLC
Doing business as
Columbus Specialty Hospital
Practice address
616 19TH St
Columbus, GA 31901-1528
Phone
(706) 494-4075
Fax
(706) 494-4090
NPI assigned
Jun 23, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
William A Eckstein, MGN
Title
Ceo
Phone
(706) 505-8654

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X 106-722 GA Primary

Addresses

Primary practice location

616 19TH St
Columbus, GA 31901-1528

Mailing address

PO Box 910
Columbus, GA 31902-0910
Phone (706) 321-6712

Other practice location 1

710 Center Street 9th Floor
Columbus, GA 31901
Phone (706) 321-6712

Other names 1

  • Columbus Specialty Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170712001971 GA Part A Provider - Hospital 0749559433 Practice locations: Columbus, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720084734. Details of each certification follow.

Hospital certification: CCN 112012

Legal name
AFFABILIS LLC
Doing business as
COLUMBUS SPECIALTY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Jan 1, 2004
Last certification
Sep 26, 2019
Beds
30
Ownership / control type
Private (for profit)
Most recent change of ownership
May 1, 2017 (1 total)
Organization structure
LLCProprietary
Incorporated
May 27, 2016 in GA
Enrollment address
616 19TH St
Columbus, GA 31901-1528
Other Hospital Practice Location
Hospital subgroups
Long-term

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Columbus Specialty Hospital, IncCCN 112012 · All quality measures
Ownership
For profit
Certified
Jan 1, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Beds
30

National Provider Directory

National Provider Directory

Locations

616 19th St
Fl 4
Columbus, GA 31901
Phone (706) 494-4075

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Michael Perez Mendez Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2017 10.99%
Robyn Nicole Cogburn Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2017 13.19%
Myra Whitley Individual W-2 Managing EmployeeAd;Chief Executive Officer Sep 29, 2023 0.55%
Woundcentrics LLC Organization, Lubbock, TX LLC Other Apr 1, 2017 1.1%
Ernest Stuart Oertli Individual Contracted Managing EmployeeVP of Operations Apr 1, 2017
5% Or Greater Indirect Ownership InterestChairman of the Board Apr 1, 2017 8.79%
Corporate Director Apr 1, 2017
Paul F Chebib Individual 5% Or Greater Indirect Ownership Interest Apr 17, 2017 8.79%
Rodney Franklin Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2017 45.05%
Timi S Tuamokumo Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2017 8.79%
Rcog LLC Organization, Lubbock, TX LLC 5% Or Greater Indirect Ownership Interest Apr 1, 2017 5%

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

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.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1720084734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 910",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319020910",
            "telephone_number": "706-321-6712",
            "fax_number": "706-321-6616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 19TH ST",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319011528",
            "telephone_number": "706-494-4075",
            "fax_number": "706-494-4090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "710 Center Street 9th Floor",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "GA",
            "postal_code": "31901",
            "country_code": "US",
            "telephone_number": "706-321-6712",
            "fax_number": "706-321-6616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AFFABILIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ECKSTEIN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-505-8654",
        "authorized_official_credential": "MGN"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "GA",
            "license": "106-722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Columbus Specialty Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Columbus Specialty Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbus, GA

Sources for this page

Verify at the official NPI Registry.