NPIMap

Organization Active NPI

Burke Hospital Company

  • Rural Health Clinic/Center
  • Waynesboro, GA
National Provider Identifier
1851969372
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BURKE HOSPITAL COMPANY
Practice address
301 Jones Ave
Waynesboro, GA 30830-1510
Phone
(706) 554-4854
NPI assigned
Jun 11, 2021
Last updated
Oct 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Authorized official

Name
Michael S Hester
Title
Ceo
Phone
(912) 369-9400

Specialties & licenses 1

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

Addresses

Primary practice location

301 Jones Ave
Waynesboro, GA 30830-1510

Mailing address

351 S Liberty St
Waynesboro, GA 30830-9686

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210721003588 GA Part A Provider - Rural Health Clinic 3476956012 Practice locations: Waynesboro, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851969372. Details of each certification follow.

Rural health clinic certification: CCN 118556

Legal name
BURKE HOSPITAL COMPANY
Doing business as
BURKE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 28, 2013
Last certification
Jul 5, 2019
Ownership / control type
2B
Organization structure
LLCProprietary
Enrollment address
301 Jones Ave
Waynesboro, GA 30830-1510
Related CCNs
110113

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Burke Hospital Company20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Ownership & related parties

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Richard William Pope Individual Other Jun 22, 2021 3.81%
Randall Meredith Individual Other Jun 22, 2021 3.81%
Nicholas Michael Capito Individual Other Jun 22, 2021 3.81%
Michael S Hester Individual W-2 Managing EmployeeCeo Jun 22, 2021
John S Clapp Individual Other Jun 22, 2021 3.81%
Jeremy Jacobs Individual Other Jun 22, 2021 3.81%
John Bojescul Individual Other Jun 22, 2021 3.81%
Terry Lee Arrington Individual Other Jun 22, 2021 3.81%
Brian E Abell Individual Other Jun 22, 2021 3.81%
Johnny Franklin Christian Individual Other Jun 22, 2021 3.81%
John H Franklin Individual Other Jun 22, 2021 3.81%
Joseph P Rectenwald Individual Other Jun 22, 2021 3.81%
Justin V Bundy Individual Other Jun 22, 2021 3.81%
Kendall Griffith Individual Other Jun 22, 2021 3.81%
David Gallagher Individual Other Jun 22, 2021 3.81%
Abraham King Lin Individual Other Jun 22, 2021 3.81%
Paul James Herzwurm Individual Other Jun 22, 2021 3.81%
Richard Vaughan Massie Individual Other Jun 22, 2021 3.81%
GK Burke, LLC Organization, Savannah, GA LLC 5% Or Greater Direct Ownership Interest Jun 22, 2021 20%
Julio E Schwarz Individual Other Jun 22, 2021 3.81%
Ty William Carter Individual Other Jun 22, 2021 3.81%
Matthew P Link Individual Other Jun 22, 2021 3.81%
Douglas R Phillips Individual Other Jun 22, 2021 3.81%

Owners & managing parties with NPI records 21

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 21

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 1

DateEventCounterparty
Jun 22, 2021 Change of OwnershipThis provider was the buyer Burke Medical Center ClinicCCN 118556, GA, NPI 1013933944

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1623369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1851969372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 S LIBERTY ST",
            "city": "WAYNESBORO",
            "state": "GA",
            "postal_code": "308309686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 JONES AVE",
            "city": "WAYNESBORO",
            "state": "GA",
            "postal_code": "308301510",
            "telephone_number": "706-554-4854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURKE HOSPITAL COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-11",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "HESTER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-369-9400"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waynesboro, GA

Sources for this page

Verify at the official NPI Registry.