PRUITTHEALTH - EASTSIDE, LLC (NPI# 1013321884) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013321884 |
| Entity Type | Organization |
| Organization Name | PRUITTHEALTH - EASTSIDE, LLC |
| Other Organization Name | PRUITTHEALTH - EASTSIDE |
| Practice Address |
2795 Finney Cir Macon GA 31217-4512 |
| Mailing Address |
1626 Jeurgens Ct Norcross GA 30093-2219 |
| Practice Telephone | 4787551875 |
| Practice Fax Number | 4787551881 |
| Mailing Telephone | 7702796200 |
| Mailing Fax Number | 7709315278 |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2016-03-30 |
| Authorized Official Name | NEIL L. PRUITT JR. (CHAIRMAN AND CEO OF MANAGER) |
| Authorized Official Telephone | 7702796200 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000140687A | 05 |
| Other Name | Type Code |
|---|---|
| PruittHealth - Eastside | Doing Business As Name - Organization |
| Street Address |
2795 FINNEY CIR |
| City | MACON |
| State | GA |
| Zip Code | 31217-4512 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144222183 | Rosewood Nursing Center Inc | Skilled Nursing Facility | 2795 Finney Cir, Macon, GA 31217-4512 | 2005-08-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326535998 | Khuzema Mohsin | Student in an Organized Health Care Education/Training Program | 380 Hospital Drive, Building A, Suite 430, Macon, GA 31217 | 2018-04-18 |
| 1083135271 | Angela Polk | Nurse Practitioner | 310 Hospital Dr Ste 305, Macon, GA 31217 | 2017-06-28 |
| 1235662305 | Natalie Rodziewicz | Student in an Organized Health Care Education/Training Program | 380 Hospital Drive, Suite 430, Macon, GA 31217 | 2017-04-06 |
| 1427430180 | Brett Forehand | Nurse Practitioner | 330 Hospital Dr Ste 304, Macon, GA 31217 | 2015-06-18 |
| 1376772640 | Beverly Barksdale Sanders IIi | Internal Medicine | 330 Hospital Dr., Ste. 304, Macon, GA 31217 | 2009-07-08 |
| 1528218393 | Vladimir Zahradnik | Surgery | 380 Hospital Dr Bldg A Ste 320, Macon, GA 31217 | 2008-09-29 |
| 1821274267 | Mary Charmaine Estrella Campana | Physical Therapist | 380 Hospital Drive, Building A, Ste. 430, Macon, GA 31217 | 2008-01-16 |
| 1033300785 | Joann Sams Sinclair | Nurse Practitioner | 4164 Riggins Mill Road, Macon, GA 31217 | 2007-08-07 |
| 1376689737 | Grier Godfrey | Dentist | Macon-bibb County Health Department, 171 Emery Highway, Macon, GA 31217 | 2007-01-30 |
| 1053408328 | Sujatha K. Reddy | Psychiatry & Neurology | 175 Emery Highway, Macon, GA 31217 | 2006-10-06 |
| Find all providers in zip 31217 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982963682 | Zebulon Park Health and Rehabilitation LLC | Skilled Nursing Facility | 343 Plantation Way, Macon, GA 31210 | 2012-05-15 |
| 1306060439 | Middle Georgia Life Care Inc. | Skilled Nursing Facility | 400 Foster Road, Macon, GA 31210 | 2007-04-12 |
| 1740341312 | Porter Field Health & Rehab Center LLC | Skilled Nursing Facility | 3051 Whiteside Rd, Macon, GA 31216-6209 | 2006-12-13 |
| 1649340167 | Goodwill Nursing Home, Inc | Skilled Nursing Facility | 4373 Houston Ave, Macon, GA 31206-2760 | 2006-11-09 |
| 1962437517 | Medical Management of Macon, Inc. | Skilled Nursing Facility | 29612 Kellogg Ave, Macon, MO 63552-3702 | 2006-07-12 |
| 1992741995 | Monroe County Nursing Home LLC | Skilled Nursing Facility | 529 Bolingreen Dr, Macon, GA 31210-5303 | 2006-06-20 |
| 1487699831 | Bibb County Health Care LLC | Skilled Nursing Facility | 3468 Napier Ave, Macon, GA 31204-3743 | 2006-06-19 |
| 1740227164 | Cherry Blossom Health Care Center LLC | Skilled Nursing Facility | 3520 Kenneth Dr, Macon, GA 31206-3824 | 2006-06-02 |
| 1093762510 | Pruitthealth - Peake, LLC | Skilled Nursing Facility | 6190 Peake Rd, Macon, GA 31220-3956 | 2006-05-29 |
| 1710934237 | Pruitthealth - Macon, LLC | Skilled Nursing Facility | 2255 Anthony Rd, Macon, GA 31204-5823 | 2006-05-29 |
| Find all providers in MACON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.