NPIMap

Organization Active NPI

Optim Orthopedics, LLC

Doing business as Optim Orthopedics

  • Orthopaedic Surgery Physician
  • Statesboro, GA
National Provider Identifier
1801280664
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
OPTIM ORTHOPEDICS, LLC
Doing business as
Optim Orthopedics
Practice address
17007 Highway 67
Statesboro, GA 30458-2426
Phone
(912) 681-2500
Fax
(912) 681-2025
NPI assigned
Mar 19, 2015
Last updated
Jul 12, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
OPTIM ORTHOPEDICS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Mike Butler
Title
Ceo
Phone
(912) 644-5300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

17007 Highway 67
Statesboro, GA 30458-2426

Mailing address

210 E Derenne Ave
Attn.: Provider Enrollment
Savannah, GA 31405-6736
Phone (912) 644-5300

Other names 1

  • Optim Orthopedics Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150429001342 GA Part B Supplier - Clinic/Group Practice 9931427002 Receives reassigned benefits from 144 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brunswick, GA; Vidalia, GA; Statesboro, GA; Savannah, GA; Rincon, GA; Richmond Hill, GA; Metter, GA; Jesup, GA…
O20151027003241 GA DME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 9931427002 Practice locations: Statesboro, GA

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 30

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

View all 30

National Provider Directory

National Provider Directory
Tax ID family
Optim Orthopedics LLC13 organizations share this tax ID, including this one
Part of
Optim Orthopedics LLC

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

503 Eisenhower Dr
Savannah, GA 31406
Phone (912) 355-6255

Practitioners & affiliated clinicians

Practitioners 6

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": "1426723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1801280664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E DERENNE AVE",
            "address_2": "ATTN.: PROVIDER ENROLLMENT",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056736",
            "telephone_number": "912-644-5300",
            "fax_number": "912-644-5260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17007 HIGHWAY 67",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304582426",
            "telephone_number": "912-681-2500",
            "fax_number": "912-681-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIM ORTHOPEDICS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPTIM ORTHOPEDICS, LLC",
        "enumeration_date": "2015-03-19",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-644-5300"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optim Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optim Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.