NPIMap

Organization Active NPI

Effingham Hospital, Inc.

Doing business as Effingham Family Medicine at Port Wentworth

  • Clinic/Center
  • Port Wentworth, GA
National Provider Identifier
1891925608
Registry record updated Nov 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EFFINGHAM HOSPITAL, INC.
Doing business as
Effingham Family Medicine at Port Wentworth
Practice address
7306 Ga Highway 21
Ste 105
Port Wentworth, GA 31407-9275
Phone
(912) 966-2575
Fax
(912) 966-0906
NPI assigned
Jul 15, 2009
Last updated
Nov 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2016

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

Authorized official

Name
Mrs. Francine Baker-Witt, RN, MBA, CNHA
Title
Interim Ceo
Phone
(912) 754-0142

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X GA Primary

Addresses

Primary practice location

7306 Ga Highway 21
Ste 105
Port Wentworth, GA 31407-9275

Mailing address

459 Highway 119 South
Attn.: Alia Allen/Medical Staff Office
Springfield, GA 31329
Phone (912) 754-0175

Other identifiers 1

IdentifierTypeStateIssuer
HOSP150OtherGAMEDICARE

Other names 1

  • Effingham Family Medicine at Port Wentworth Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170113001163 GA Part B Supplier - Clinic/Group Practice 1254628092 Receives reassigned benefits from 35 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Guyton, GA; Port Wentworth, GA; Rincon, GA; Springfield, GA

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Effingham Hospital Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

459 Highway 119 S
Ofc
Springfield, GA 31329

Practitioners & affiliated clinicians

Practitioners 1

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": "1247616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480377600000",
    "number": "1891925608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "459 HIGHWAY 119 SOUTH",
            "address_2": "ATTN.: ALIA ALLEN/MEDICAL STAFF OFFICE",
            "city": "SPRINGFIELD",
            "state": "GA",
            "postal_code": "31329",
            "telephone_number": "912-754-0175",
            "fax_number": "912-754-6395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7306 GA HIGHWAY 21",
            "address_2": "STE 105",
            "city": "PORT WENTWORTH",
            "state": "GA",
            "postal_code": "314079275",
            "telephone_number": "912-966-2575",
            "fax_number": "912-966-0906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EFFINGHAM HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-15",
        "last_updated": "2016-11-29",
        "status": "A",
        "authorized_official_last_name": "BAKER-WITT",
        "authorized_official_first_name": "FRANCINE",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "912-754-0142",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, MBA, CNHA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "HOSP150",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Effingham Family Medicine at Port Wentworth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Wentworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; 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.