NPIMap

Organization Active NPI

Southeast Lung & Critical Care Specialists, PC

Doing business as Southeast Lung Associates

  • Pulmonary Disease Physician
  • Savannah, GA
National Provider Identifier
1972901395
Registry record updated Dec 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC
Doing business as
Southeast Lung Associates
Practice address
5354 Reynolds St
Suite #318
Savannah, GA 31405-6007
Phone
(912) 629-2290
Fax
(912) 629-2291
NPI assigned
Dec 17, 2014
Last updated
Dec 17, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2014

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

Authorized official

Name
April Young
Title
Practice Administrator
Phone
(912) 629-0457

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X NU Primary

Addresses

Primary practice location

5354 Reynolds St
Suite #318
Savannah, GA 31405-6007

Mailing address

PO Box 14417
Savannah, GA 31416-1417
Phone (912) 629-2290

Other identifiers 1

IdentifierTypeStateIssuer
000526336AMedicaidGA

Other names 1

  • Southeast Lung Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040415000176 GA Part B Supplier - Clinic/Group Practice 7618962291 Receives reassigned benefits from 29 practitioners
33 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jesup, GA; Vidalia, GA; Tybee Island, GA; Sylvania, GA; Springfield, GA; Savannah, GA; Hinesville, GA; Brunswick, GA…

Other NPIs on the same Medicare enrollment 33

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 33

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1418774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418774400000",
    "number": "1972901395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14417",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314161417",
            "telephone_number": "912-629-2290",
            "fax_number": "912-629-2291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5354 REYNOLDS ST",
            "address_2": "SUITE #318",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056007",
            "telephone_number": "912-629-2290",
            "fax_number": "912-629-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-17",
        "last_updated": "2014-12-17",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "APRIL",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "912-629-0457"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000526336A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Lung Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; 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.