NPIMap

Organization Active NPI

St. Mary'S Medical Group, Inc.

  • Obstetrics & Gynecology Physician
  • Greensboro, GA
National Provider Identifier
1891069290
Registry record updated Apr 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
63440 Issued in GA
Legal business name
ST. MARY'S MEDICAL GROUP, INC.
Practice address
1000 Cowles Clinc Way
Suite D-300
Greensboro, GA 30642-5285
Phone
(762) 243-3860
Fax
(762) 243-3879
NPI assigned
Mar 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2018

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

Authorized official

Name
D. Montez Carter
Title
President & Ceo
Phone
(706) 389-3930

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X 63440 GA Primary

Addresses

Primary practice location

1000 Cowles Clinc Way
Suite D-300
Greensboro, GA 30642-5285

Mailing address

1000 Cowles Clinc Way
Suite D-300
Greensboro, GA 30642-5285
Phone (762) 243-3860

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080616000388 GA Part B Supplier - Clinic/Group Practice 7113098393 Receives reassigned benefits from 126 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Athens, GA; Bogart, GA; Greensboro, GA; Lavonia, GA; Monroe, GA; Watkinsville, GA

Other NPIs on the same Medicare enrollment 28

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

View all 28

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1330646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522713600000",
    "number": "1891069290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 COWLES CLINC WAY",
            "address_2": "SUITE D-300",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "306425285",
            "telephone_number": "762-243-3860",
            "fax_number": "762-243-3879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 COWLES CLINC WAY",
            "address_2": "SUITE D-300",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "306425285",
            "telephone_number": "762-243-3860",
            "fax_number": "762-243-3879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-02",
        "last_updated": "2018-04-03",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "D. MONTEZ",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "706-389-3930"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "63440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2018; 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.