NPIMap

Organization Active NPI

Phoebe Worth Medical Center, Inc

  • Rural Health Clinic/Center
  • Sylvester, GA
National Provider Identifier
1891770764
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PHOEBE WORTH MEDICAL CENTER, INC
Practice address
1014 W Franklin St
Sylvester, GA 31791-1978
Phone
(229) 776-2965
Fax
(229) 776-4452
NPI assigned
Dec 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Authorized official

Name
Stacey L Flynt
Title
Business Office Manager
Phone
(229) 777-4514

Specialties & licenses 1

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

Addresses

Primary practice location

1014 W Franklin St
Sylvester, GA 31791-1978

Mailing address

PO Box 545
807 S Isabella Street
Sylvester, GA 31791-0545
Phone (229) 776-2965

Other identifiers 1

IdentifierTypeStateIssuer
00002109EMedicaidGA

Other names 1

  • Phoebe Worth Family Medicine Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040205000529 GA Part B Supplier - Clinic/Group Practice 0840104527 Receives reassigned benefits from 57 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sylvester, GA
O20071112000045 GA Part A Provider - Rural Health Clinic 0840104527 Practice locations: Sylvester, GA

Rural health clinic certification: CCN 113477

Legal name
PHOEBE WORTH MEDICAL CENTER, INC
Doing business as
PHOEBE WORTH FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 19, 1997
Last certification
Mar 10, 2021
Ownership / control type
2B
Most recent change of ownership
May 1, 2002 (1 total)
Organization structure
CorporationNon-profit
Incorporated
May 1, 2002 in GA
Enrollment address
1014 W Franklin St
Sylvester, GA 31791-1978
Related CCNs
111328

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Phoebe Putney Fam Med2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

807 S Isabella St
Sylvester, GA 31791
Phone (229) 777-3851

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
John Anthony Nesmith Individual Corporate OfficerVolunteer Board Member Mar 1, 2022
Mary Givens Individual Corporate OfficerVolunteer Board Member May 5, 2015
Toney Christopher Shipp Individual Corporate OfficerVolunteer Board Member Mar 1, 2022
Johnny Cochran Individual Corporate OfficerVolunteer Board Member May 5, 2015
Phoebe Putney Health Systems Inc Organization, Albany, GA Non-profit 5% Or Greater Direct Ownership Interest Feb 12, 2008
Candace Guarnieri Individual Corporate OfficerCfo May 5, 2015
Scott Steiner Individual Corporate OfficerCeo Mar 1, 2019
Brian a Church Individual W-2 Managing EmployeeCfo/Cao Mar 1, 2022
Grace Violet Davis Individual Corporate OfficerVolunteer Board Member Mar 1, 2022
Don Mock Individual Corporate OfficerVolunteer Board Member May 5, 2015

Facilities with the same owner 10

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

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1891770764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 545",
            "address_2": "807 S ISABELLA STREET",
            "city": "SYLVESTER",
            "state": "GA",
            "postal_code": "317910545",
            "telephone_number": "229-776-2965",
            "fax_number": "229-776-4452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 W FRANKLIN ST",
            "city": "SYLVESTER",
            "state": "GA",
            "postal_code": "317911978",
            "telephone_number": "229-776-2965",
            "fax_number": "229-776-4452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOEBE WORTH MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-13",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "FLYNT",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "229-777-4514"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00002109E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoebe Worth Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sylvester, GA

Sources for this page

Verify at the official NPI Registry.