NPIMap

Organization Active NPI

Colquitt Regional Medical Center

Doing business as Colquitt Regional Primary Care Clinic

  • Rural Health Clinic/Center
  • Moultrie, GA
National Provider Identifier
1881758753
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
14029 Issued in GA
Legal business name
COLQUITT REGIONAL MEDICAL CENTER
Doing business as
Colquitt Regional Primary Care Clinic
Sterling Group Family Care
Practice address
6 Hospital Park
Moultrie, GA 31768-6700
Phone
(229) 985-3320
Fax
(229) 890-1282
NPI assigned
Dec 21, 2006
Last updated
Sep 4, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
COLQUITT REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Authorized official

Name
James L Matney
Title
Ceo
Phone
(229) 985-3420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 14029 GA Primary

Addresses

Primary practice location

6 Hospital Park
Moultrie, GA 31768-6700

Mailing address

PO Box 2876
Moultrie, GA 31776-2876
Phone (229) 985-3320

Other names 2

  • Colquitt Regional Primary Care Clinic Doing business as
  • Sterling Group Family Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040415000368 GA Part B Supplier - Clinic/Group Practice 6204821796 Receives reassigned benefits from 77 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Moultrie, GA
O20090828000451 GA Part A Provider - Rural Health Clinic 6204821796 Practice locations: Moultrie, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881758753. Details of each certification follow.

Rural health clinic certification: CCN 113422

Legal name
COLQUITT REGIONAL MEDICAL CENTER
Doing business as
COLQUITT REGIONAL PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 1, 1995
Last certification
Jun 27, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 14, 1938 in GA
Enrollment address
6 Hospital Park
Moultrie, GA 31768-6700
Related CCNs
110105

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Colquitt Regional Med C14 organizations share this tax ID, including this one
Part of
Colquitt Regional Med C

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Samantha Allen Individual Operational/Managerial ControlVP Practice Management Oct 1, 2023
Jayshree a Bhavnani Individual Corporate OfficerCfo Jan 1, 2024
Jimmy Matney Individual Corporate OfficerCeo Jan 1, 2020

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Colquitt Regional Home Care ServicesMoultrie, GA, CCN 117044 Home health agency Operational/Managerial Control Feb 1, 1987
Colquitt Regional HospiceMoultrie, GA, CCN 111542 Hospice 5% Or Greater Direct Ownership Interest (100%) Oct 13, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 11

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": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756944000000",
    "number": "1881758753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2876",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317762876",
            "telephone_number": "229-985-3320",
            "fax_number": "229-890-1282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 HOSPITAL PARK",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686700",
            "telephone_number": "229-985-3320",
            "fax_number": "229-890-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLQUITT REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLQUITT REGIONAL MEDICAL CENTER",
        "enumeration_date": "2006-12-21",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A",
        "authorized_official_last_name": "MATNEY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-985-3420"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "GA",
            "license": "14029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colquitt Regional Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sterling Group Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moultrie, GA

Sources for this page

Verify at the official NPI Registry.