NPIMap

Organization Active NPI

Department of Behavioral Health and Developmental Disabilities

Doing business as Central State Hospital

  • Psychiatric Hospital
  • Milledgeville, GA
National Provider Identifier
1902030307
Registry record updated May 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
005-3263 Issued in GA
Legal business name
DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES
Doing business as
Central State Hospital
Practice address
620 Broad St
Milledgeville, GA 31062-7525
Phone
(478) 445-4128
NPI assigned
May 13, 2009
Last updated
May 13, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2009

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

Authorized official

Name
Mr. Marvin Bailey
Title
Regional Hospital Administrator
Phone
(478) 445-4128

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 005-3263 GA Primary

Addresses

Primary practice location

620 Broad St
Milledgeville, GA 31062-7525

Mailing address

620 Broad St
Milledgeville, GA 31062-7525
Phone (478) 445-4128

Other names 1

  • Central State Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090825000435 GA Part B Supplier - Clinic/Group Practice 7416002506 Receives reassigned benefits from 178 practitioners
7 other NPIs on this enrollment
Practice locations: Augusta, GA; Columbus, GA; Decatur, GA; Milledgeville, GA; Rome, GA; Savannah, GA; Thomasville, GA

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Department of Behavioral Health Developmental Disabilities Ga53 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Locations

3405 Old Savannah Rd
Augusta, GA 30906
Phone (705) 790-2030

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
West Central Georgia Regional HospitalColumbus, GA, CCN 114013 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 2009
Georgia Regional Hospital at SavannahSavannah, GA, CCN 114028 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2009
Georgia Regional Hospital at AtlantaDecatur, GA, CCN 114019 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jul 1, 2009
Jul 1, 2009

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 185

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.

View all 185

NPI Registry JSON

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

{
    "created_epoch": "1242172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242172800000",
    "number": "1902030307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 BROAD ST",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310627525",
            "telephone_number": "478-445-4128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 BROAD ST",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310627525",
            "telephone_number": "478-445-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-13",
        "last_updated": "2009-05-13",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_title_or_position": "REGIONAL HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "478-445-4128",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "GA",
            "license": "005-3263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central State Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milledgeville, GA

Sources for this page

Verify at the official NPI Registry.