NPIMap

Organization Active NPI

Tift Regional Health System, Inc.

  • Community Based Hospice Care Agency
  • Tifton, GA
National Provider Identifier
1902909427
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
137-180 Issued in GA
Legal business name
TIFT REGIONAL HEALTH SYSTEM, INC.
Practice address
618 Central Ave N
Tifton, GA 31794-4336
Phone
(229) 353-6330
NPI assigned
Sep 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Authorized official

Name
Christopher Dorman
Title
President/Ceo
Phone
(229) 353-6104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 137-180 GA Primary

Addresses

Primary practice location

618 Central Ave N
Tifton, GA 31794-4336

Mailing address

PO Box 2650
Tifton, GA 31793-2650
Phone (229) 353-3422

Other practice location 1

104 8th St W
Suite 1
Tifton, GA 31794-3985
Phone (229) 353-6208

Other identifiers 1

IdentifierTypeStateIssuer
000407569AMedicaidGA

Other names 1

  • Hospice of Tift Area Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200122001935 GA Part A Provider - Hospice 2062745169 Practice locations: Tifton, GA

Hospice certification: CCN 111520

Legal name
TIFT REGIONAL HEALTH SYSTEM INC
Doing business as
HOSPICE OF TIFT AREA
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 1, 1989
Last certification
Apr 4, 2019
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 30, 2019 in GA
Enrollment address
618 Central Ave North
Tifton, GA 31794-4336

Other NPIs with the same Medicare PAC ID 12

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of Tift AreaCCN 111520
Ownership
Other
Certified
Jun 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Tift Regional Health System Inc20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Locations

104 8th St W
Ste 1
Tifton, GA 31794
Phone (229) 353-6208

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Jessica W Beier Individual Corporate DirectorDirector Dec 20, 2018
George Hunt Individual Corporate DirectorDirector Dec 20, 2018
Rubal Patel Individual Corporate DirectorDirector Dec 20, 2023
Scott Fulp Individual Corporate DirectorDirector Apr 17, 2019
James W Scott Individual Corporate DirectorDirector Apr 17, 2019
Mary T Mathis Individual W-2 Managing EmployeeAd; Mar 1, 2019
Kristy Gladden Individual W-2 Managing EmployeeProvider Enrollment Manager Apr 6, 2022
Lenton C Daughtrey Individual Corporate DirectorDirector Apr 17, 2019
William Bowen Individual Corporate DirectorDirector Dec 20, 2018
Troy Brooks Individual Corporate OfficerSVP/Cfo Jun 27, 2022
W-2 Managing Employee Jun 27, 2022
Craig Smith Individual W-2 Managing EmployeeMD; Oct 1, 2022

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Southwell Medical Sylvia Barr CenterAdel, GA, CCN 11S101 Hospital Operational/Managerial Control Jul 1, 2012
Tift Regional Health System IncTifton, GA, CCN 110095 Hospital Operational/Managerial Control Mar 1, 2019
Southwell Health and RehabilitationAdel, GA, CCN 115655 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF
Direct Ownership Interest (100%)		 Mar 1, 2019
Mar 1, 2019
May 15, 2025
Mar 1, 2019
Southwell Medical Adel Primary CareAdel, GA, CCN 118528 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2019
Southwell MedicalSylvester, GA, CCN 118578 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 12, 2012
Southwell Medical Ashburn Primary CareAshburn, GA, CCN 118574 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 12, 2012
Southwell MedicalNashville, GA, CCN 118577 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 12, 2012
Southwell Medical Community HealthTifton, GA, CCN 118576 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 12, 2012

Owned or controlled facilities with NPI records 8

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

Practitioners & affiliated clinicians

Practitioners 294

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

View all 294

Affiliated clinicians 11

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664323200000",
    "number": "1902909427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2650",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317932650",
            "telephone_number": "229-353-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 CENTRAL AVE N",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317944336",
            "telephone_number": "229-353-6330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 8th St W",
            "address_2": "Suite 1",
            "address_purpose": "LOCATION",
            "city": "Tifton",
            "state": "GA",
            "postal_code": "317943985",
            "country_code": "US",
            "telephone_number": "229-353-6208",
            "fax_number": "229-353-7722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIFT REGIONAL HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "DORMAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "229-353-6104"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": "137-180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000407569A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospice of Tift Area",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hospice of Tift Area",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.