NPIMap

Organization Active NPI

Colquitt Regional Medical Center

Doing business as Colquitt Regional Geriatric Behavioral Health

  • Psychiatric Hospital Unit
  • Moultrie, GA
National Provider Identifier
1982295036
Registry record updated Feb 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
COLQUITT REGIONAL MEDICAL CENTER
Doing business as
Colquitt Regional Geriatric Behavioral Health
Practice address
3131 S Main St
Moultrie, GA 31768-6925
Phone
(229) 985-3420
NPI assigned
Feb 1, 2021
Last updated
Feb 1, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COLQUITT REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

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

Authorized official

Name
Jim Matney
Title
Ceo
Phone
(229) 890-3570

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X NU Primary

Addresses

Primary practice location

3131 S Main St
Moultrie, GA 31768-6925

Mailing address

PO Box 40
Moultrie, GA 31776-0040
Phone (229) 891-9164

Other names 1

  • Colquitt Regional Geriatric Behavioral Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080329000094 GA Part A Provider - Hospital 6204821796 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Moultrie, GA
O20230127001726 GA Part A Provider - Hospital 6204821796 Practice locations: Moultrie, GA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1982295036. Details of each certification follow.

Hospital certification: CCN 110105

Legal name
COLQUITT REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 26, 2024
Beds
99
Ownership / control type
Hospital district or authority
Organization structure
CorporationNon-profit
Incorporated
Jul 14, 1938 in GA
Enrollment address
3131 S Main St
Moultrie, GA 31768-6925
Other Hospital Practice Location
Hospital subgroups
Acute care

Hospital certification: CCN 11S105

Legal name
COLQUITT REGIONAL MEDICAL CENTER
Organization structure
CorporationNon-profit
Enrollment address
3131 S Main St
Moultrie, GA 31768-6925
Hospital Psychiatric Unit
Hospital subgroups
General, Acute care, Psychiatric unit

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Colquitt Regional Medical CenterCCN 110105 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Part of
Robert Hawes MD

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Richard Bass Individual Corporate Director Oct 1, 2011
Howard Laney Melton Individual Corporate Director Nov 7, 2007
Jayshree a Bhavnani Individual Corporate OfficerCfo Jan 1, 2022
Corporate OfficerCfo/Ao Jan 1, 2022
Justin a Baker Individual Corporate Director Jan 1, 2022
Kirk R Friedlander Individual Corporate Director Nov 7, 2007
Shamb G. Purohit Individual W-2 Managing EmployeeVP Finance Sep 1, 2013
W-2 Managing EmployeeVP Finance/Ao Sep 1, 2013
John M Mobley Individual Corporate Director Nov 7, 2007
Corporate Director Jan 1, 2022
Jimmy Matney Individual Corporate DirectorCeo Oct 1, 2011
W-2 Managing EmployeeCeo Oct 1, 2011
Maureen Yearta Individual Corporate Director Jan 1, 2022
Richard Turner Individual Corporate Director Jan 1, 2022
Brooks Sheldon Individual Corporate Director Nov 7, 2007

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 2

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

FacilityTypeRoleSince
Colquitt Regional Home Care ServicesMoultrie, GA, CCN 117044 Home health agency Operational/Managerial Control Feb 1, 1987
Colquitt Regional HospiceMoultrie, GA, CCN 111542 Hospice 5% Or Greater Direct Ownership Interest (100%) Oct 13, 2015

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 197

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 197

NPI Registry JSON

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

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612137600000",
    "number": "1982295036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317760040",
            "telephone_number": "229-891-9164",
            "fax_number": "229-891-9186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686925",
            "telephone_number": "229-985-3420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLQUITT REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLQUITT REGIONAL MEDICAL CENTER",
        "enumeration_date": "2021-02-01",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A",
        "authorized_official_last_name": "MATNEY",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-890-3570"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colquitt Regional Geriatric Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moultrie, GA

Sources for this page

Verify at the official NPI Registry.