NPIMap

Individual provider Active NPI

Kenneth M Eugene, MD

  • Family Medicine Physician
  • Rincon, GA
National Provider Identifier
1801950530
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
GA035866 Issued in GA
Practice address
423 S. Columbia Avenue
Rincon, GA 31326-1399
Phone
(912) 826-8860
Fax
(912) 826-2813
NPI assigned
Dec 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X GA035866 GA Primary

Addresses

Primary practice location

423 S. Columbia Avenue
Rincon, GA 31326-1399

Mailing address

602 E 72ND St
Savannah, GA 31405-4913
Phone (912) 819-7878

Other identifiers 2

IdentifierTypeStateIssuer
003153414AMedicaidGA
80042556OtherGARAILROAD PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041210000168 GA Practitioner - Family Practice 4082671110 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wright State University Boonshoft School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SJC Medical Group IncGroup PAC ID 7719978105, 57 clinicians

Practice addresses (Care Compare)

11705 Mercy Blvd
Savannah, GA 31419-1711
Phone (912) 819-4949

423 S Columbia Ave
Rincon, GA 31326-9080
Phone (912) 826-8860

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
GA035866GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SJC Medical Group Inc Family Medicine CurrentSince Jan 12, 2015 Accepting new patients
Steward Center for Palliative Care CurrentSince Jan 1, 2024 Accepting new patients
Premise Health of Georgia Medical PC CurrentSince Jan 1, 1998 Accepting new patients
Premise Health of Georgia Medical, P.C. Family Medicine Current Accepting new patients
Premise Health of Georgia Medical PC Family Medicine CurrentSince Jan 1, 1998 Accepting new patients
Hospice Savannah, Inc Family Medicine CurrentSince Jan 1, 2024 Accepting new patients

Locations

1128 S Park St
Carrollton, GA 30117
Phone (770) 836-0770

423 S Columbia Ave
Rincon, GA 31326
Phone (912) 826-2944

1352 Eisenhower Dr
Savannah, GA 31406
Phone (912) 354-8014

11705 Mercy Blvd
Savannah, GA 31419
Phone (912) 819-2452

310 Eisenhower Dr
Ste 7A
Savannah, GA 31406
Phone (912) 355-6503

836 E 65th St
Ste 4
Savannah, GA 31405
Phone (912) 303-1309

602 E 72nd St
Savannah, GA 31405
Phone (912) 819-7800

16906 Collection Ctr Dr
Chicago, IL 60693

Interoperability endpoints

  • Direct secure messaging: dreugene@direct.sjchs.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488240000000",
    "number": "1801950530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 E 72ND ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314054913",
            "telephone_number": "912-819-7878",
            "fax_number": "912-819-7850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "423 S. COLUMBIA AVENUE",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313261399",
            "telephone_number": "912-826-8860",
            "fax_number": "912-826-2813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EUGENE",
        "first_name": "KENNETH",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2017-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "GA035866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003153414A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PROVIDER NUMBER",
            "identifier": "80042556",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rincon, GA

Sources for this page

Verify at the official NPI Registry.