Organization Active NPI

Regenerative Healthcare, LLC

  • Internal Medicine Physician
  • Savannah, GA
National Provider Identifier
1841769718
Registry record updated Mar 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
REGENERATIVE HEALTHCARE, LLC
Practice address
329 Eisenhower Dr Ste D
Savannah, GA 31406-2695
Phone
(912) 661-0450
Fax
(912) 348-3104
NPI assigned
Nov 20, 2018
Last updated
Mar 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2022

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

Authorized official

Name
Shelley Wilkins
Title
Practice Manager
Phone
(912) 655-6217

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

329 Eisenhower Dr Ste D
Savannah, GA 31406-2695

Mailing address

114 Canal St Ste 603
Pooler, GA 31322-4292
Phone (912) 665-6217

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190307001733 GA Part B Supplier - Clinic/Group Practice 4688913775 Receives reassigned benefits from 2 practitioners
Practice locations: Savannah, GA

National Provider Directory

National Provider Directory

Locations

329 Eisenhower Dr
Ste D
Savannah, GA 31406
Phone (912) 351-0005

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1542672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647302400000",
    "number": "1841769718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 CANAL ST STE 603",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224292",
            "telephone_number": "912-665-6217",
            "fax_number": "912-348-3104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 EISENHOWER DR STE D",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062695",
            "telephone_number": "912-661-0450",
            "fax_number": "912-348-3104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENERATIVE HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-20",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A",
        "authorized_official_last_name": "WILKINS",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "912-655-6217"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; 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.