NPIMap

Organization Active NPI

SJC Medical Group Inc

  • Family Medicine Physician
  • Savannah, GA
National Provider Identifier
1811233828
Registry record updated Jan 23, 2017
On this page

Key facts

NPPES NPI Registry
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
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2017

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

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X

Addresses

Primary practice location

527 Eisenhower Dr
Savannah, GA 31406-2668

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040524000690 GA Part B Supplier - Clinic/Group Practice 7719978105 Receives reassigned benefits from 57 practitioners
Practice locations: Statesboro, GA; Savannah, GA; Richmond Hill, GA; Rincon, GA; Hinesville, GA; Jesup, GA; Pembroke, GA; Pooler, GA
O20130625000361 GA Part A Provider - Rural Health Clinic 7719978105 Practice locations: Metter, GA
O20130702000782 SC Part B Supplier - Clinic/Group Practice 7719978105 Receives reassigned benefits from 11 practitioners
Practice locations: Bluffton, SC; Ridgeland, SC

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

National Provider Directory

National Provider Directory

Member organizations 2

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

Locations

229 W General Screven Way
Ste H1A
Hinesville, GA 31313
Phone (912) 756-3872

125 Memorial Dr
Ste C
Jesup, GA 31545

101 Saint Josephs Candler Dr
Ste 200
Pooler, GA 31322
Phone (912) 748-1999

101 Saint Josephs Candler Dr
Ste 330
Pooler, GA 31322
Phone (912) 737-2450

101 Saint Josephs Candler Dr
Ste 350
Pooler, GA 31322

119 Canal St
Ste 106
Pooler, GA 31322
Phone (912) 348-3003

101 Saint Josephs Candler Dr
Ste 320
Pooler, GA 31322
Phone (912) 355-6503

10055 Ford Ave
Ste 3C
Richmond Hill, GA 31324
Phone (912) 303-9355

527 Eisenhower Dr
Savannah, GA 31406
Phone (912) 443-4200

11700 Mercy Blvd
Ste 1B
Savannah, GA 31419
Phone (912) 819-7878

4849 Paulsen St
Ste 105
Savannah, GA 31405
Phone (912) 819-3944

100 Eisenberg Dr
Savannah, GA 31406
Phone (912) 819-7447

5354 Reynolds St
Ste 303
Savannah, GA 31405
Phone (912) 352-7902

5105 Paulsen St
Ste 211
Savannah, GA 31405
Phone (912) 921-7714

5354 Reynolds St
Ste 416
Savannah, GA 31405

5 Lake St
Savannah, GA 31411
Phone (912) 295-4220

102 Bryan Woods Rd
Savannah, GA 31410
Phone (912) 828-1122

352 Commercial Dr
Savannah, GA 31406
Phone (912) 352-3668

11705 Mercy Blvd
Bldg 5
Savannah, GA 31419

10 Oak Forest Rd
Ste Cb
Bluffton, SC 29910

81 Main St
Hilton Head, SC 29926
Phone (843) 681-1680

Ownership & related parties

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.

NameRoleSinceShare
Gregory J Schaack Individual Corporate OfficerCfo/Board Member Jul 1, 2000
Corporate DirectorCfo/Board Member Jul 1, 2000
W-2 Managing EmployeeCfo/Board Member Jul 1, 2000
Paul P Hinchey Individual Corporate OfficerPresident & Ceo Jul 1, 2000
Corporate DirectorPresident & Ceo Jul 1, 2000
SJC Ventures, Inc Organization, Savannah, GA Corporation 5% Or Greater Direct Ownership Interest Jul 1, 2000 100%

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
SJC Medical Group-PembrokePembroke, GA, CCN 113841 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 1993
May 1, 1993

Owned or controlled facilities with NPI records 1

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

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.

Practitioners & affiliated clinicians

Practitioners 115

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 115

NPI Registry JSON

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": []
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.