NPIMap

Organization Active NPI

Wayne SJC Medical Group, LLC

  • Orthopaedic Surgery Physician
  • Jesup, GA
National Provider Identifier
1851730626
Registry record updated Jun 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
025763 Issued in GA
Legal business name
WAYNE SJC MEDICAL GROUP, LLC
Practice address
330 Peachtree St
Suite 2
Jesup, GA 31545-0244
Phone
(912) 427-6915
Fax
(912) 427-4455
NPI assigned
Jun 14, 2013
Last updated
Jun 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2013

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

Authorized official

Name
Mr. Paul Hinchey
Title
President/Ceo
Phone
(912) 819-6901

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 025763 GA Primary

Addresses

Primary practice location

330 Peachtree St
Suite 2
Jesup, GA 31545-0244

Mailing address

330 Peachtree St
Suite 2
Jesup, GA 31545-0244

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120817000029 GA Part B Supplier - Clinic/Group Practice 5496901811 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Blackshear, GA; Jesup, GA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

790 Veterans Parkway
Ste 112
Hinesville, GA 31313
Phone (912) 368-3709

125 Memorial Dr
Ste B
Jesup, GA 31545

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1371168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371168000000",
    "number": "1851730626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 PEACHTREE ST",
            "address_2": "SUITE 2",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315450244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 PEACHTREE ST",
            "address_2": "SUITE 2",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315450244",
            "telephone_number": "912-427-6915",
            "fax_number": "912-427-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE SJC MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-14",
        "last_updated": "2013-06-14",
        "status": "A",
        "authorized_official_last_name": "HINCHEY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "912-819-6901",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "GA",
            "license": "025763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jesup, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; 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.