NPIMap

Organization Active NPI

1St America Infusion Services LLC

Doing business as Advanced InfusionCare

  • Home Infusion Therapy Pharmacy
  • Valdosta, GA
National Provider Identifier
1851309595
Registry record updated Nov 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
Legal business name
1ST AMERICA INFUSION SERVICES LLC
Doing business as
Advanced InfusionCare
Practice address
212 Northside Dr
Valdosta, GA 31602-1858
Phone
(229) 242-3060
Fax
(292) 242-9914
NPI assigned
Aug 4, 2006
Last updated
Nov 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2022

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

Authorized official

Name
Simon Castellanos
Title
Ceo
Phone
(601) 988-1700

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X PHRE008040 GA
Home Infusion Therapy Pharmacy 3336H0001X Primary
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

212 Northside Dr
Valdosta, GA 31602-1858

Mailing address

212 Northside Dr
Valdosta, GA 31602-1858
Phone (229) 242-3040

Other identifiers 2

IdentifierTypeStateIssuer
323764040AMedicaidGA
2019860OtherPK

Other names 1

  • Advanced InfusionCare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments
Home infusion therapy
Medicare-enrolled home infusion therapy supplier

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930080149 GA DME Supplier - Pharmacy 9537259783 Practice locations: Valdosta, GA
O20210111002622 GA Part B Supplier - Home Infusion Therapy Supplier 9537259783 Practice locations: Valdosta, GA

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory

Locations

212 Northside Dr
Valdosta, GA 31602
Phone (229) 242-3060

212 Northside Dr
#B
Valdosta, GA 31602
Phone (229) 242-3060

212 Northside Dr
Ste B
Valdosta, GA 31602

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1851309595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 NORTHSIDE DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021858",
            "telephone_number": "229-242-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 NORTHSIDE DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021858",
            "telephone_number": "229-242-3060",
            "fax_number": "292-242-9914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1ST AMERICA INFUSION SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "CASTELLANOS",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-988-1700"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "PHRE008040",
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "323764040A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2019860",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced InfusionCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.