Phoebe Worth Medical Center, Inc
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Sylvester, GA
NPI 1760460448 · NPPES record last updated Nov 15, 2007
Key facts
- NPI
- 1760460448
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- Legal business name
- PHOEBE WORTH MEDICAL CENTER, INC
- Practice address
- 807 S Isabella St
Sylvester, GA 31791-7554 - Phone
- (229) 777-4514
- Fax
- (229) 776-7062
- NPI assigned
- Jan 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Stacey L. Flynt
- Title
- Business Office Manager
- Phone
- (229) 777-4514
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 1
Facilities with the same owner 10
Practitioners 57
-
Edward King Bass III, M.D.
-
Lisa M Frazier, NP
-
Katherine Jean Hanson, FNP-BC
-
Mana L Kasongo, MD
-
Patricia Mason, FNP
-
Samuel Ojewale, MD
-
Greta S Slappy, FNP
-
Wael Azer Aziz Azer, D.O.
-
James Sirleaf, MD
-
Wallace A Ajakaiye, M.D
-
Kesha L Allen, MD
-
Julie S Bennett, NP
-
James E Black, MD
-
Jason B Boyd, NP
-
Shashank Kumar Jha, MBBS, FNP, PMHNP-BC
-
Brian K. Jordan, D.O.
Affiliated clinicians 6
-
James E Black, MD
-
Mana L Kasongo, MD
-
Daren Kyle Wooten, M.D.
-
Wael Azer Aziz Azer, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Hospital certification: CCN 11Z328
- Legal name
- PHOEBE WORTH MEDICAL CENTER, INC
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 807 S Isabella St Sylvester
Sylvester, GA 31791-7554
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| John Anthony Nesmith |
Corporate Officer |
Mar 1, 2022 | |
| Mary Givens |
Corporate Officer |
Feb 11, 2015 | |
| Kim S Gilman |
W-2 Managing Employee |
Feb 11, 2015 | |
| Toney Christopher Shipp |
Corporate Officer |
Mar 1, 2022 | |
| Stacey Flynt |
W-2 Managing Employee |
Feb 11, 2015 | |
| Johnny Cochran |
Corporate Officer |
Feb 11, 2015 | |
| Phoebe Putney Health Systems Inc |
Operational/Managerial Control | Feb 12, 2008 | |
| Candace Guarnieri |
Corporate Officer |
Feb 11, 2015 | |
| Scott Steiner |
Corporate Officer |
Mar 1, 2022 | |
| Brian a Church |
Corporate Officer |
Mar 1, 2022 | |
| Grace Violet Davis |
Corporate Officer |
Mar 1, 2022 | |
| Don Mock |
Corporate Officer |
Feb 11, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040205000529 | GA | Part B Supplier - Clinic/Group Practice | 0840104527 |
Receives reassigned benefits from 57 practitioners 3 other NPIs on this enrollment Practice locations: Sylvester, GA |
| O20220912002020 | GA | Part a Provider - Critical Access Hospital | 0840104527 | Practice locations: Sylvester, GA |
National Provider Directory
Locations
810 13th Ave
Ste 105
Albany, GA 31701
Phone (229) 446-8960
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | Yes |
Addresses
Primary practice location
807 S Isabella St
Sylvester, GA 31791-7554
Mailing address
807 S Isabella St
P.O. Box 545
Sylvester, GA 31791-7554
Phone (229) 777-4514
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000490 | Other | GA | BLUE CROSS |
| 00002109S | Medicaid | GA |
Other names
- Phoebe Worth Medical Center, Inc
Other providers in Sylvester, GA
- Jana Patton
- Monica Brittany Perry
- Pharmacy on Main LLC
- Phoebe Worth Medical Center
- Phoebe Worth Medical Center, Inc
- Phoebe Worth Medical Center, Inc
- Pine Shadows Retirement Manor
- Premiercare @Home LLC
- Premiercare Transportation LLC
- Pruitthealth - Sylvester, LLC
All providers in Sylvester, GA · Medicare Defined Swing Bed Hospital Unit in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.