NPIMap

Organization Active NPI

Lookout Mountain Community Services

  • Community/Behavioral Health Agency
  • Summerville, GA
National Provider Identifier
1720150907
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LOOKOUT MOUNTAIN COMMUNITY SERVICES
Practice address
83 Highway 48
Summerville, GA 30747-1506
Phone
(706) 857-5441
Fax
(706) 857-7607
NPI assigned
Nov 14, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Thomas W. Ford, PH.D.NPI 1457417792
Title
Executive Director
Phone
(706) 638-5584

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

83 Highway 48
Summerville, GA 30747-1506

Mailing address

PO Box 1027
La Fayette, GA 30728-1027
Phone (706) 638-5584

Other identifiers 1

IdentifierTypeStateIssuer
00604513E-32MedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040506000251 GA Part B Supplier - Clinic/Group Practice 4880682822 Receives reassigned benefits from 28 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: La Fayette, GA; Ft. Oglethorpe, GA; Trenton, GA; Summerville, GA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Lookout Mountain Community Services107 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

83 Highway 48
Summerville, GA 30747
Phone (706) 857-5441

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720150907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1027",
            "city": "LA FAYETTE",
            "state": "GA",
            "postal_code": "307281027",
            "telephone_number": "706-638-5584",
            "fax_number": "706-638-5585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 HIGHWAY 48",
            "city": "SUMMERVILLE",
            "state": "GA",
            "postal_code": "307471506",
            "telephone_number": "706-857-5441",
            "fax_number": "706-857-7607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOOKOUT MOUNTAIN COMMUNITY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "706-638-5584",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00604513E-32",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.