Port Medical Management Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PORT MEDICAL MANAGEMENT INC

Doing business as

The Bridge

Practice address

920 S West St
Bainbridge, GA 39819-4581

Phone

(229) 400-0498

NPI assigned

Feb 4, 2020

Last updated

Feb 5, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Moore

Title

Office Manager

Phone

(229) 400-0498

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• THE BRIDGE Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 3

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.

• Kimberely Dawn Johnson, APRN, FNP-C

  • Family Nurse Practitioner
  • Cairo, GA
  • NPI 1215416516
  Medicare reassignment Care Compare group NPD
• Zacharey Alan Powell, DNP, FNP-C

  • Family Medicine Physician
  • Bainbridge, GA
  • NPI 1851884068
  Medicare reassignment Care Compare group NPD
• Darrell Shawn Surratt, MD

  • Family Medicine Physician
  • Bainbridge, GA
  • NPI 1972570943
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1580774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1932731361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "922 S WEST ST",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194581",
            "telephone_number": "229-248-8499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 S WEST ST",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194581",
            "telephone_number": "229-400-0498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT MEDICAL MANAGEMENT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-04",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "229-400-0498"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY PRACTICE",
            "identifier": "1013306547",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY PRACTICE",
            "identifier": "1174851745",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY PRACTICE",
            "identifier": "1972570943",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE BRIDGE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "THE BRIDGE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Port City Family Dental Associates
• Port City Family Medicine, L.L.C.
• Port City Medical Associates Inc (Bainbridge Treatment Center)
• Port City Pulmonary Care, Inc.
• Port City Urgent Care L.L.C.
• Jennifer T. Powell
• Zacharey Alan Powell, DNP, FNP-C
• Laura Ashley Pratt, PTA
• Melody Elise Price, LCSW
• Winston Price, M.D.

• Family Medicine Physician in Bainbridge, GA
• Providers in Bainbridge, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.