Organization Active NPI

Integrative Health PC

  • Psychiatry Physician
  • Valdosta, GA
National Provider Identifier
1962780171
Registry record updated Feb 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
54448 Issued in GA
Legal business name
INTEGRATIVE HEALTH PC
Practice address
2935 N Ashley St
Suite 114
Valdosta, GA 31602-1777
Phone
(229) 219-1831
NPI assigned
Jul 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2012

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

Authorized official

Name
Mrs. Tiffany Michelle Kumpel, MD
Title
President
Phone
(229) 333-9632

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 54448 GA Primary

Addresses

Primary practice location

2935 N Ashley St
Suite 114
Valdosta, GA 31602-1777

Mailing address

2935 N Ashley St Ste 114
Valdosta, GA 31602-1788
Phone (229) 219-1831

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110930000418 GA Part B Supplier - Clinic/Group Practice 7719159441 Receives reassigned benefits from 1 practitioner
Practice locations: Valdosta, GA

National Provider Directory

National Provider Directory

Locations

116 W Thigpen Ave
Ste A
Lakeland, GA 31635
Phone (229) 219-1831

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1311292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330473600000",
    "number": "1962780171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2935 N ASHLEY ST STE 114",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021788",
            "telephone_number": "229-219-1831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2935 N ASHLEY ST",
            "address_2": "SUITE 114",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021777",
            "telephone_number": "229-219-1831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE HEALTH PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-22",
        "last_updated": "2012-02-29",
        "status": "A",
        "authorized_official_last_name": "KUMPEL",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "229-333-9632",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "54448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2012; 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.