NPIMap

Organization Active NPI

Skidaway Medical Group LLC

Doing business as Primary Care Wilmington Island

  • Primary Care Clinic/Center
  • Savannah, GA
National Provider Identifier
1982360236
Registry record updated Nov 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SKIDAWAY MEDICAL GROUP LLC
Doing business as
Primary Care Wilmington Island
Practice address
212 Johnny Mercer Blvd
Savannah, GA 31410-2156
Phone
(912) 201-1140
NPI assigned
Nov 11, 2021
Last updated
Nov 16, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SKIDAWAY MEDICAL GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 16, 2021

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

Authorized official

Name
Brittany Wilson
Title
Manager
Phone
(912) 201-1140

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

212 Johnny Mercer Blvd
Savannah, GA 31410-2156

Mailing address

212 Johnny Mercer Blvd # B
Savannah, GA 31410-2156
Phone (912) 201-1140

Other names 1

  • PRIMARY CARE WILMINGTON ISLAND Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220118000620 GA Part B Supplier - Clinic/Group Practice 3173915527 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Savannah, GA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Skidaway Medical Group LLC

Locations

212 Johnny Mercer Blvd
#B
Savannah, GA 31410
Phone (912) 201-1140

212 Johnny Mercer Blvd
Ste B
Savannah, GA 31410

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1636588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637020800000",
    "number": "1982360236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 JOHNNY MERCER BLVD # B",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314102156",
            "telephone_number": "912-201-1140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 JOHNNY MERCER BLVD",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314102156",
            "telephone_number": "912-201-1140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIDAWAY MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SKIDAWAY MEDICAL GROUP LLC",
        "enumeration_date": "2021-11-11",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "912-201-1140"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRIMARY CARE WILMINGTON ISLAND",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRIMARY CARE WILMINGTON ISLAND",
            "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 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.