SJC Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SJC MEDICAL GROUP INC

Practice address

527 Eisenhower Dr
Savannah, GA 31406-2668

Phone

(912) 819-9100

Fax

(912) 819-9100

NPI assigned

Dec 19, 2012

Last updated

Jan 23, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donna J Stephens

Title

Credentialing Coordinator

Phone

(912) 819-7878

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, SC3 enrollments

Enrollment records 3

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811233828. Details of each certification follow.

• CCN 118906 Rural health clinic · Active · Details

Rural health clinic certification: CCN 118906

Legal name

SJC MEDICAL GROUP INC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Aug 10, 2011

Last certification

Mar 17, 2022

Ownership / control type

1B

Most recent change of ownership

Apr 1, 2013 (1 total)

Organization structure

CorporationProprietary

Incorporated

Oct 20, 1992 in GA

Enrollment address

10 Doctors St
Metter, GA 30439-3337

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

• Candler Medical Group, Inc. - Metter

  • Family Medicine Physician
  • Metter, GA
  • NPI 1023039732

  Member Of

  NPD member
• Saint Josephs Medical Group Inc

  • Family Medicine Physician
  • Pembroke, GA
  • NPI 1154349850

  Member Of

  NPD member

Locations

All disclosed owners & managing parties 3

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

All facility ownership & control disclosures 1

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

Owned or controlled facilities with NPI records 1

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

• Saint Josephs Medical Group Inc

  • Family Medicine Physician
  • Pembroke, GA
  • NPI 1154349850

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Saint Josephs Medical Group Inc

  • Family Medicine Physician
  • Pembroke, GA
  • NPI 1154349850
  NPPES parent name

Practitioners 115

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.

• Joenie T Almeida, M.D.

  • Internal Medicine Physician
  • Savannah, GA
  • NPI 1447271333
  Medicare reassignment Care Compare group NPD
• Jerrod Anderson

  • Family Medicine Physician
  • Richmond Hill, GA
  • NPI 1013302587
  Medicare reassignment Care Compare group NPD
• Kara Baker

  • Family Nurse Practitioner
  • Pembroke, GA
  • NPI 1386183879
  Medicare reassignment Care Compare group NPD
• Lisa A Bozik, MD

  • Internal Medicine Physician
  • Savannah, GA
  • NPI 1831206382
  Medicare reassignment Care Compare group NPD
• Robert Nolan Brackenrich, DO

  • Family Medicine Physician
  • Pooler, GA
  • NPI 1215559687
  Medicare reassignment Care Compare group NPD
• Chandler Paradise Brandenburg, MD

  • Family Medicine Physician
  • Pembroke, GA
  • NPI 1326626615
  Medicare reassignment Care Compare group NPD
• Andrew Michael Carney, DO

  • Family Medicine Physician
  • Hinesville, GA
  • NPI 1861921868
  Medicare reassignment Care Compare group NPD
• Stephanie Renee Denmark, FNP-BC

  • Nurse Practitioner
  • Pooler, GA
  • NPI 1184006462
  Medicare reassignment Care Compare group NPD
• William Embrey, MD

  • Family Medicine Physician
  • Pooler, GA
  • NPI 1508506577
  Medicare reassignment Care Compare group NPD
• Kenneth M Eugene, MD

  • Family Medicine Physician
  • Rincon, GA
  • NPI 1801950530
  Medicare reassignment Care Compare group NPD
• Francisco Fantauzzi-Nazario, M.D.

  • Family Medicine Physician
  • Savannah, GA
  • NPI 1821161688
  Medicare reassignment Care Compare group NPD
• Kathleen Alice Flynn, N.P.

  • Family Nurse Practitioner
  • Savannah, GA
  • NPI 1528497500
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1355875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485129600000",
    "number": "1811233828",
    "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": "527 EISENHOWER DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062668",
            "telephone_number": "912-819-9100",
            "fax_number": "912-819-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SJC MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-19",
        "last_updated": "2017-01-23",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "912-819-7878"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• SJ Cooper, LLC (SJC Beauty)
• SJ SC Cardiology LLC
• SJC Electrophysiology, LLC
• SJC General Surgery LLC
• SJC Home Health Services Inc
• SJC Oncology Services - Georgia, LLC
• SJC Oncology Services-Georgia, LLC
• SJC Thoracic Services, LLC
• Craig Kevin Skalla, DPM
• Ellen Skeadas Grody, PA-C

• Family Medicine Physician in Savannah, GA
• Providers in Savannah, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.