NPIMap

Organization Active NPI

Phoebe Putney Memorial Hospital, Inc.

  • Rural Health Clinic/Center
  • Camilla, GA
National Provider Identifier
1821293788
Registry record updated May 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PHOEBE PUTNEY MEMORIAL HOSPITAL, INC.
Practice address
48 US Highway 19 S
Camilla, GA 31730-1960
Phone
(229) 336-5208
Fax
(229) 336-8260
NPI assigned
Jun 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2014

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

Authorized official

Name
Robert Lagesse
Title
Sr VP Physician Services
Phone
(229) 312-4055

Specialties & licenses 1

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

Addresses

Primary practice location

48 US Highway 19 S
Camilla, GA 31730-1960

Mailing address

PO Box 3109
Albany, GA 31706-3109
Phone (229) 312-5800

Other identifiers 2

IdentifierTypeStateIssuer
GRP1226OtherGAMEDICARE GROUP
000001482MMedicaidGA

Other names 1

  • Phoebe Family Medical Center - Camilla Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031202000200 GA Part B Supplier - Clinic/Group Practice 4486559549 Receives reassigned benefits from 2 practitioners
2 other NPIs on this enrollment
Practice locations: Albany, GA; Pelham, GA; Dawson, GA; Arlington, GA; Camilla, GA

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 172

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

View all 172

NPI Registry JSON

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401408000000",
    "number": "1821293788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3109",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317063109",
            "telephone_number": "229-312-5800",
            "fax_number": "229-312-5853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 US HIGHWAY 19 S",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317301960",
            "telephone_number": "229-336-5208",
            "fax_number": "229-336-8260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOEBE PUTNEY MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-19",
        "last_updated": "2014-05-30",
        "status": "A",
        "authorized_official_last_name": "LAGESSE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "SR VP PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "229-312-4055"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "GRP1226",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000001482M",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoebe Family Medical Center - Camilla",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Camilla, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2014; 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.