NPIMap

Organization Active NPI

Phoebe Worth Medical Center, Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Sylvester, GA
National Provider Identifier
1760460448
Registry record updated Nov 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
PHOEBE WORTH MEDICAL CENTER, INC
Doing business as
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
Last updated
Nov 15, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2007

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

Authorized official

Name
Stacey L. Flynt
Title
Business Office Manager
Phone
(229) 777-4514

Specialties & licenses 1

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

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 names 1

  • Phoebe Worth Medical Center, Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760460448. Details of each certification follow.

Hospital certification: CCN 11Z328

Legal name
PHOEBE WORTH MEDICAL CENTER, INC
Organization structure
CorporationNon-profit
Enrollment address
807 S Isabella St Sylvester
Sylvester, GA 31791-7554
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

807 S Isabella St
Sylvester, GA 31791
Phone (229) 777-3851

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
John Anthony Nesmith Individual Corporate OfficerVolunteer Board Member Mar 1, 2022
Mary Givens Individual Corporate OfficerVolunteer Board Member Feb 11, 2015
Kim S Gilman Individual W-2 Managing EmployeeCeo Feb 11, 2015
Toney Christopher Shipp Individual Corporate OfficerVolunteer Board Member Mar 1, 2022
Stacey Flynt Individual W-2 Managing EmployeeOffice Manager Feb 11, 2015
Johnny Cochran Individual Corporate OfficerVolunteer Board Member Feb 11, 2015
Phoebe Putney Health Systems Inc Organization, Albany, GA Non-profit Operational/Managerial Control Feb 12, 2008
Candace Guarnieri Individual Corporate OfficerCfo Feb 11, 2015
Scott Steiner Individual Corporate OfficerVolunteer Board Member Mar 1, 2022
Brian a Church Individual Corporate OfficerVolunteer Board Member Mar 1, 2022
Grace Violet Davis Individual Corporate OfficerVolunteer Board Member Mar 1, 2022
Don Mock Individual Corporate OfficerVolunteer Board Member Feb 11, 2015

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 57

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.

View all 57

Affiliated clinicians 6

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": "1136332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195084800000",
    "number": "1760460448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 S ISABELLA ST",
            "address_2": "P.O. BOX 545",
            "city": "SYLVESTER",
            "state": "GA",
            "postal_code": "317917554",
            "telephone_number": "229-777-4514",
            "fax_number": "229-776-7062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 S ISABELLA ST",
            "city": "SYLVESTER",
            "state": "GA",
            "postal_code": "317917554",
            "telephone_number": "229-777-4514",
            "fax_number": "229-776-7062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOEBE WORTH MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-04",
        "last_updated": "2007-11-15",
        "status": "A",
        "authorized_official_last_name": "FLYNT",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "229-777-4514"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoebe Worth Medical Center, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sylvester, GA

Sources for this page

Verify at the official NPI Registry.