PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC (NPI# 1154795581) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1154795581 |
Entity Type | Organization |
Organization Name | PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC |
Practice Address |
11 Upper Riverdale Rd Sw Riverdale GA 30274-2615 |
Practice Telephone | 7709918000 |
Mailing Telephone | 7709918000 |
Enumeration Date | 2015-11-23 |
Last Update Date | 2017-02-23 |
Authorized Official Name | CHRISTOPHER DOAN (CHIEF COMPLIANCE COUNSEL) |
Authorized Official Telephone | 9092354307 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
Y | 282N00000X | General Acute Care Hospital | 031-442 | GA | Hospitals |
State | Issuer | Identifier | Type Code |
---|---|---|---|
GA | 00000404A | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518440254 | Prime Healthcare Foundation - Southern Regional, LLC | Psychiatric Unit | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2018-09-10 |
1679946669 | Prime Healthcare Foundation - Southern Regional, LLC | Rehabilitation Unit | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2015-11-12 |
Street Address |
11 UPPER RIVERDALE RD SW |
City | RIVERDALE |
State | GA |
Zip Code | 30274-2615 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1831190958 | Southern Regional Health System, Inc | General Acute Care Hospital | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2005-08-10 |
1639796212 | Georgia Em-i Medical Service PC | Physician Assistant | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2020-06-30 |
1093331308 | Harmony Grove Emergency Physicians LLC | Emergency Medicine | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2020-06-23 |
1366092827 | Evan Chandler Burrowes | Dietitian, Registered | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2019-09-17 |
1932676681 | Ashley Lauren King | Physician Assistant | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2018-10-31 |
1518440254 | Prime Healthcare Foundation - Southern Regional, LLC | Psychiatric Unit | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2018-09-10 |
1730660093 | Virginia Tittle Kee | Nurse Practitioner | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2018-08-24 |
1245724723 | Kelly Henry | Registered Nurse | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274 | 2018-06-19 |
1053821777 | Angelyn Levell-smith | Nurse Practitioner | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2017-10-08 |
1932625548 | Lpp of Georgia LLC | Emergency Medicine | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2017-08-15 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1245862507 | Todd L. Reed | Chiropractor | 83 Upper Riverdale Rd, Riverdale, GA 30274 | 2020-02-05 |
1487135992 | Freddie L Sallette IIi | Technician, Pathology | 385 Brookview Dr, Riverdale, GA 30274 | 2018-08-22 |
1366933210 | Dawn A. Paul | Nurse Practitioner | 238 Professional Ct Ste A, Riverdale, GA 30274 | 2018-05-27 |
1851894588 | Absolute Health Family & Urgent Care Clinic | Clinic/Center | 7574 Ga 85, Riverdale, GA 30274 | 2018-03-08 |
1366972127 | Jamillah Ingram | Physical Therapy Assistant | 315 Upper Riverdale Rd., Riverdale, GA 30274 | 2017-06-14 |
1114456514 | Grace L Kelson | Licensed Practical Nurse | 9142 Clubhouse Dr, Riverdale, GA 30274 | 2017-06-08 |
1790167799 | Cristian Carbuccia | Internal Medicine | 33 Upper Riverdale Rd Sw Ste 10, Riverdale, GA 30274 | 2015-06-25 |
1265857692 | Right Choice Enterprises LLC | Technician | 638 Sterling Ct, Riverdale, GA 30274 | 2014-02-21 |
1942571625 | Lowes Guardian Angel LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7056 Eunice Dr., Riverdale, GA 30274 | 2012-01-26 |
1508134156 | Education System Management, Inc | Social Worker | 125 Highway 138, Riverdale, GA 30274 | 2011-12-12 |
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Taxonomy Code | 282N00000X |
Grouping | Hospitals |
Classification | General Acute Care Hospital |
An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1649645011 | Clarence Waugh | General Acute Care Hospital | 171 Sterling Ridge Dr, Riverdale, GA 30274-4637 | 2015-12-09 |
1831190958 | Southern Regional Health System, Inc | General Acute Care Hospital | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2005-08-10 |
1558814459 | Atlanta Kidney Specialists LLC | General Acute Care Hospital | 253 Upper Riverdale Rd Sw, Suite B, Riverdale, GA 30274-4945 | 2016-07-27 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902459316 | Au Medical Center, Inc | General Acute Care Hospital | 1348 Walton Way Ste 6300c, Augusta, GA 30901-5104 | 2019-07-24 |
1841651056 | Kamran Rajaee | General Acute Care Hospital | 5081 Sunset Trl, Marietta, GA 30068-4734 | 2016-03-15 |
1144687070 | Globale, LLC | General Acute Care Hospital | 750 Dalrymple Rd Apt B2, Atlanta, GA 30328-1434 | 2016-01-22 |
1548632045 | Allbright Professional Blood Services | General Acute Care Hospital | 1043 River Forest Pt, Lawrenceville, GA 30045-2600 | 2015-10-22 |
1790173094 | Piedmont Healthcare | General Acute Care Hospital | 2124 Mckinley Rd Nw, Atlanta, GA 30318-1708 | 2015-01-08 |
1790183622 | Pauline L. Jacinto Md | General Acute Care Hospital | 104 Lakeshore Dr Ste B, Saint Marys, GA 31558-3809 | 2014-12-09 |
1073937892 | Emory University Hospital | General Acute Care Hospital | 5207 Peachtree Creek Cir, Atlanta, GA 30341-5364 | 2014-02-13 |
1063856706 | Keystone Surgical Associates | General Acute Care Hospital | 2525 Kirk Pointe Cv Nw, Kennesaw, GA 30152-6239 | 2013-04-24 |
1679810022 | Proficiency Scribes Cs, LLC | General Acute Care Hospital | 114 Bradley Rd, Jackson, GA 30233-3702 | 2013-01-04 |
1891045191 | South Georgia Medical Center | General Acute Care Hospital | 2501 North Patterson St, Valdosta, GA 31636 | 2012-09-13 |
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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.