NPIMap

Organization Active NPI

Hospital Authority of Ben Hill

Doing business as Dorminy Medical Center Swingbed

  • Medicare Defined Swing Bed Hospital Unit
  • Fitzgerald, GA
National Provider Identifier
1720173917
Registry record updated Jul 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
HOSPITAL AUTHORITY OF BEN HILL
Doing business as
Dorminy Medical Center Swingbed
Practice address
200 Perry House Rd
Fitzgerald, GA 31750-8857
Phone
(229) 424-7100
NPI assigned
Oct 4, 2006
Last updated
Jul 23, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2009

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

Authorized official

Name
Mrs. Paige P Wynn
Title
Cfo
Phone
(229) 424-7100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

200 Perry House Rd
Fitzgerald, GA 31750-8857

Mailing address

200 Perry House Rd
Fitzgerald, GA 31750-8857
Phone (229) 424-7100

Other names 1

  • Dorminy Medical Center Swingbed Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260512001082 GA Part A Provider - Hospital 3678461373 Practice locations: Fitzgerald, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720173917. Details of each certification follow.

Hospital certification: CCN 11Z339

Legal name
HOSPITAL AUTHORITY OF BEN HILL
Doing business as
DORMINY MEMORIAL HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
200 Perry House Rd
Fitzgerald, GA 31750-8857
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Nate Wilson Individual Corporate DirectorCfo Mar 18, 2026
W-2 Managing Employee Mar 18, 2026
Paige P Wynn Individual Corporate DirectorCeo Mar 18, 2026
W-2 Managing Employee Mar 18, 2026

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
DMC Internal Medicine and Family Health ClinicFitzgerald, GA, CCN 113466 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2014

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248307200000",
    "number": "1720173917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PERRY HOUSE RD",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "317508857",
            "telephone_number": "229-424-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PERRY HOUSE RD",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "317508857",
            "telephone_number": "229-424-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF BEN HILL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2009-07-23",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "PAIGE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-424-7100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dorminy Medical Center Swingbed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fitzgerald, GA

Sources for this page

Verify at the official NPI Registry.