NPIMap

Organization Active NPI

Southeast Lung & Critical Care Specialists, PC

  • Pulmonary Disease Physician
  • Columbus, GA
National Provider Identifier
1730501735
Registry record updated May 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC
Practice address
1921 Whittlesey Rd
Suite # 530
Columbus, GA 31904-3099
Phone
(912) 629-2290
Fax
(912) 629-2291
NPI assigned
Jan 9, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2014

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

Authorized official

Name
April Young
Title
Practice Administrator
Phone
(912) 629-0457

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

1921 Whittlesey Rd
Suite # 530
Columbus, GA 31904-3099

Mailing address

PO Box 14417
Savannah, GA 31416-1417
Phone (912) 629-2290

Other identifiers 9

IdentifierTypeStateIssuer
003129391AMedicaidGA
795377228AMedicaidGA
000526336AMedicaidGA
003124134CMedicaidGA
003129392AMedicaidGA
003134446AMedicaidGA
003137375AMedicaidGA
221012519BMedicaidGA
003126241AMedicaidGA

Other names 1

  • Southeast Lung Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040415000176 GA Part B Supplier - Clinic/Group Practice 7618962291 Receives reassigned benefits from 29 practitioners
33 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jesup, GA; Vidalia, GA; Tybee Island, GA; Sylvania, GA; Springfield, GA; Savannah, GA; Hinesville, GA; Brunswick, GA…

Other NPIs on the same Medicare enrollment 33

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

View all 33

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1389225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398988800000",
    "number": "1730501735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14417",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314161417",
            "telephone_number": "912-629-2290",
            "fax_number": "912-629-2291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 WHITTLESEY RD",
            "address_2": "SUITE # 530",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319043099",
            "telephone_number": "912-629-2290",
            "fax_number": "912-629-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-09",
        "last_updated": "2014-05-02",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "APRIL",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "912-629-0457"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003129391A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "795377228A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000526336A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003124134C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003129392A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003134446A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003137375A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "221012519B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003126241A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Lung Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbus, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2014; 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.