NPIMap

Organization Active NPI

Hospital Authority of Jefferson County and the City of Louisville

Doing business as Wrens Physicians' Health Group

  • Rural Health Clinic/Center
  • Wrens, GA
National Provider Identifier
1801801543
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE
Doing business as
Wrens Physicians' Health Group
Practice address
400 Canterbury Dr
Wrens, GA 30833-4072
Phone
(478) 625-7000
Fax
(478) 625-8907
NPI assigned
Jul 30, 2006
Last updated
Sep 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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

Authorized official

Name
Jessica Guy
Title
Assistant Administrator
Phone
(478) 625-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

400 Canterbury Dr
Wrens, GA 30833-4072

Mailing address

400 Canterbury Dr
Wrens, GA 30833-4072
Phone (478) 625-7000

Other identifiers 1

IdentifierTypeStateIssuer
000001031EMedicaidGA

Other names 1

  • Wrens Physicians' Health Group Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040226001055 GA Part B Supplier - Clinic/Group Practice 7214823046 Receives reassigned benefits from 16 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Louisville, GA; Wadley, GA; Wrens, GA
O20071207000901 GA Part A Provider - Rural Health Clinic 7214823046 Practice locations: Wrens, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801801543. Details of each certification follow.

Rural health clinic certification: CCN 113498

Legal name
HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE
Doing business as
WRENS PHYSICIANS HEALTH GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 4, 2002
Last certification
Dec 19, 2024
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Aug 26, 1977 in GA
Enrollment address
400 Canterbury Dr
Wrens, GA 30833-4072
Related CCNs
110100

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0992706Wrens Physicians' Health Group400 Canterbury Drive, Wrens, GA 30833Provider-performed microscopyFeb 8, 2028

National Provider Directory

National Provider Directory
Tax ID family
Jefferson Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
William Easterlin Individual Corporate Director Oct 1, 2007
Jessica Guy Individual W-2 Managing Employee Jan 1, 2017
John Johnson Individual Corporate Director Oct 1, 2007
Lee Woods Individual Corporate DirectorBoard Member Jan 1, 2011
Wendy Martin Individual Corporate OfficerCeo Sep 9, 2019
Mary Clark Individual Corporate Director Oct 1, 2007

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Jefferson HospitalLouisville, GA, CCN 11U100 Hospital Operational/Managerial Control
Other		 Aug 26, 1977
Aug 26, 1977
Jefferson HospitalLouisville, GA, CCN 11S100 Hospital Operational/Managerial Control Aug 26, 1977
Physicians Health Group WadleyWadley, GA, CCN 113453 Rural health clinic Operational/Managerial Control
Other		 Sep 10, 2014
Aug 26, 1977
Physicians Health GroupLouisville, GA, CCN 113420 Rural health clinic 5% Or Greater Direct Ownership Interest
Other		 Aug 26, 1977
Aug 26, 1977

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 10

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": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600732800000",
    "number": "1801801543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CANTERBURY DR",
            "city": "WRENS",
            "state": "GA",
            "postal_code": "308334072",
            "telephone_number": "478-625-7000",
            "fax_number": "478-625-8907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CANTERBURY DR",
            "city": "WRENS",
            "state": "GA",
            "postal_code": "308334072",
            "telephone_number": "478-625-7000",
            "fax_number": "478-625-8907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A",
        "authorized_official_last_name": "GUY",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "ASSISTANT ADMINISTRATOR",
        "authorized_official_telephone_number": "478-625-7000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000001031E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wrens Physicians' Health Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wrens Physicians' Health Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wrens, GA

Sources for this page

Verify at the official NPI Registry.