NPIMap

Organization Active NPI

Jasper Health Services, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Monticello, GA
National Provider Identifier
1972715795
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
079592 Issued in GA
Legal business name
JASPER HEALTH SERVICES, INC.
Doing business as
Jasper Memorial Hospital
Practice address
898 College St
Monticello, GA 31064-1261
Phone
(706) 468-6411
Fax
(706) 468-9880
NPI assigned
May 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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

Authorized official

Name
Robert A Cumbie, PHARMD
Title
Ceo
Phone
(706) 468-4595

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 079592 GA Primary

Addresses

Primary practice location

898 College St
Monticello, GA 31064-1261

Mailing address

898 College St
Monticello, GA 31064-1261
Phone (706) 468-6411

Other names 1

  • Jasper Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080612000852 GA Part A Provider - Critical Access Hospital 7214901230 Practice locations: Monticello, GA

Hospital certification: CCN 11Z303

Legal name
JASPER HEALTH SERVICES INC.
Doing business as
JASPER MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2000 in GA
Enrollment address
898 College St
Monticello, GA 31064-1258
Hospital Swing-Bed Unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Jasper Health Services Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Alison Hildebrant Individual Corporate Director Jan 1, 2000
Laura E Hudgins Individual W-2 Managing Employee Dec 9, 2016
Janelyn Gaston Individual W-2 Managing EmployeeAdministrator Jan 1, 2000
Lyndsy a Johnston Individual Corporate Director Dec 20, 2019
Stuart Abney Individual W-2 Managing Employee Mar 26, 2007
Steven Walker Jordan Individual Corporate Director Dec 20, 2019
Nataliya a Kubasova Individual W-2 Managing EmployeeMedical Staff Director Sep 7, 2015
Donna Holman Individual W-2 Managing Employee Jan 1, 2000
Angela C Gordon Individual Corporate Director Dec 20, 2019
David Leach Individual Corporate Officer Jan 15, 2013

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
The RetreatMonticello, GA, CCN 115675 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF
Direct Ownership Interest (100%)		 Jan 1, 2000
Jan 1, 2000
Jan 1, 2000
Jan 1, 2000

Owned or controlled facilities with NPI records 1

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

  • Jasper Health Services Inc.
    • Skilled Nursing Facility
    • Monticello, GA
    • NPI 1518956481

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698192000000",
    "number": "1972715795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "898 COLLEGE ST",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310641261",
            "telephone_number": "706-468-6411",
            "fax_number": "706-468-9880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "898 COLLEGE ST",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310641261",
            "telephone_number": "706-468-6411",
            "fax_number": "706-468-9880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASPER HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A",
        "authorized_official_last_name": "CUMBIE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-468-4595",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "GA",
            "license": "079592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jasper Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jasper Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monticello, GA

Sources for this page

Verify at the official NPI Registry.