Vidalia Immediate & Primary Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

VIDALIA IMMEDIATE & PRIMARY CARE LLC

Practice address

122 Alice Coleman Drive
Vidalia, GA 30474

Phone

(912) 805-2273

NPI assigned

Aug 2, 2021

Last updated

Nov 16, 2021By 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

Melissa Ann Beckum

Title

Practice Manager/Office Manager

Phone

(912) 293-2869

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GICFDD

Practitioners 13

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.

• Melanie Crooms Bailey

  • Family Nurse Practitioner
  • Vidalia, GA
  • NPI 1952137903
  Medicare reassignment Care Compare group NPD
• Dustin J Carter, MPAS, PA-C

  • Medical Physician Assistant
  • Vidalia, GA
  • NPI 1982698361
  Medicare reassignment Care Compare group NPD
• Alexis Byrd Fountain, FNP-C

  • Family Nurse Practitioner
  • Vidalia, GA
  • NPI 1821724386
  Medicare reassignment Care Compare group NPD
• Dewey D Howell, FNP-C

  • Family Nurse Practitioner
  • Vidalia, GA
  • NPI 1467808279
  Medicare reassignment Care Compare group NPD
• James L Ray, MD

  • Family Medicine Physician
  • Swainsboro, GA
  • NPI 1679523419
  Medicare reassignment Care Compare group NPD
• Lindsey Ruple, ARPN

  • Family Nurse Practitioner
  • Vidalia, GA
  • NPI 1346058542
  Medicare reassignment Care Compare group NPD
• Joseph Gerard Foust, MD

  • Family Medicine Physician
  • Navarre, FL
  • NPI 1407837438

  GA

  Medicare reassignment Care Compare group NPD
• Tenesa Stokes Lightsey, FNP-C

  • Family Nurse Practitioner
  • Scottsdale, AZ
  • NPI 1033837760

  GA

  Medicare reassignment Care Compare group NPD
• Amanda Lariscey, PA-C

  • Physician Assistant
  • Vidalia, GA
  • NPI 1780164590
  Medicare reassignment Care Compare group
• James R Payne, PA C

  • Physician Assistant
  • Vidalia, GA
  • NPI 1114912524
  Medicare reassignment Care Compare group
• Chastity Hinson, NP

  • Nurse Practitioner
  • Reidsville, GA
  • NPI 1649013368
  Medicare reassignment NPD
• Ian C Munger, DO

  • Emergency Medicine Physician
  • Statesboro, GA
  • NPI 1023247723
  Medicare reassignment NPD

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637020800000",
    "number": "1942974167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2324",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304752324",
            "telephone_number": "912-805-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 ALICE COLEMAN DRIVE",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "30474",
            "telephone_number": "912-805-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDALIA IMMEDIATE & PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-02",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A",
        "authorized_official_last_name": "BECKUM",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRACTICE MANAGER/OFFICE MANAGER",
        "authorized_official_telephone_number": "912-293-2869"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vidalia Health Services, LLC
• Vidalia Health Services, LLC (Memorial Health Meadows Hospital Imaging Center)
• Vidalia Health Services, LLC
• Vidalia Health Services, LLC (Sleep Center-Vidalia, a department of Memorial Health Meadows Hospital)
• Vidalia Imaging Associates, LLC
• Vidalia Lab Services, Inc
• Vidalia Medical Associates, PC
• Vidalia Medical Partners Inc. (1st Choice Family Medical Group)
• Vidalia Neurology Associates, LLC
• Vidalia OB GYN

• Primary Care Clinic/Center in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.