NPIMap

Organization Active NPI

Bryan County Health Department

  • Public Health or Welfare Agency
  • Pembroke, GA
National Provider Identifier
1992895122
Registry record updated Jan 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
BRYAN COUNTY HEALTH DEPARTMENT
Practice address
430 Ledford Street
Pembroke, GA 31321-0009
Phone
(912) 653-4331
Fax
(912) 653-4328
NPI assigned
Oct 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2015

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

Authorized official

Name
Mrs. Stacy A Cooper
Title
District Dept Billing Coordinator
Phone
(912) 262-2347

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X Primary

Addresses

Primary practice location

430 Ledford Street
Pembroke, GA 31321-0009

Mailing address

150 Scranton Connector
Brunswick, GA 31525-0540
Phone (912) 262-2347

Other identifiers 6

IdentifierTypeStateIssuer
000051818BMedicaidGA
000456508AMedicaidGA
000457938BMedicaidGA
000551922AMedicaidGA
FLU139OtherGAMEDICARE NUMBER
000453219EMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050328000342 GA Part B Supplier - Public Health/Welfare Agency 2860448487 Practice locations: Pembroke, GA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Bryan County Health Dep2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

66 Cpt Matthew Freeman Dr
Richmond Hill, GA 31324
Phone (912) 756-2611

Practitioners & affiliated clinicians

Practitioners 7

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": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420502400000",
    "number": "1992895122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 SCRANTON CONNECTOR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315250540",
            "telephone_number": "912-262-2347",
            "fax_number": "912-262-3036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 LEDFORD STREET",
            "city": "PEMBROKE",
            "state": "GA",
            "postal_code": "313210009",
            "telephone_number": "912-653-4331",
            "fax_number": "912-653-4328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN COUNTY HEALTH DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2015-01-06",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DISTRICT DEPT BILLING COORDINATOR",
        "authorized_official_telephone_number": "912-262-2347",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000051818B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000456508A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000457938B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000551922A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NUMBER",
            "identifier": "FLU139",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000453219E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; 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.