Pediatrics of Glynn on the Island

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PEDIATRICS OF GLYNN ON THE ISLAND

Practice address

172 Follins LN
St Simons Island, GA 31522-4268

Phone

(912) 634-2795

Fax

(912) 638-5636

NPI assigned

Apr 2, 2007

Organization subpart

No

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

Authorized official

Name

Pamela C Lumpkin

Title

Practice Manager

Phone

(912) 634-2795

Specialties & licenses 1

Addresses

Other identifiers 12

Practitioners 1

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

• Carole Lyons, PNP

  • Pediatric Nurse Practitioner
  • St Simons Island, GA
  • NPI 1245338912
  NPD (past)

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831210657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 FOLLINS LN",
            "city": "ST SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315224268",
            "telephone_number": "912-634-2795",
            "fax_number": "912-638-5636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 FOLLINS LN",
            "city": "ST SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315224268",
            "telephone_number": "912-634-2795",
            "fax_number": "912-638-5636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS OF GLYNN ON THE ISLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUMPKIN",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "912-634-2795"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEE HEERY AMERIGROUP",
            "identifier": "10065447",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FRANCES OWEN BCBS #",
            "identifier": "963103",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAROLE LYONS AMERIGROUP #",
            "identifier": "10066660",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAROLE LYONS WELLCARE#",
            "identifier": "335886",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEE HEERY NPI#",
            "identifier": "1699873299",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00672977B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEE HEERY BCBS GA #",
            "identifier": "969118",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00760966B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAROLE LYONS NPI",
            "identifier": "12545338912",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEE HEERY WELLCARE #",
            "identifier": "365007",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWEN  AMERIGROUP#",
            "identifier": "10066698",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWEN  WELLCARE#",
            "identifier": "335898",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rainey Reanna Olliff, PA-C
• Frances L Owen, M.D.
• Pacella Counseling LLC
• Gwen Jean Pacella, LCSW
• Mary Rainey Parker, PT
• Performance Physio LLC
• Melinda H Peterlin, MD
• Karol Summers Pfister, RPH
• Physical Therapy Plus, Inc
• Physical Therapy Plus, Inc

• Pediatrics Physician in St Simons Island, GA
• Providers in St Simons Island, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.