PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC (NPI# 1679946669) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679946669 |
| 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 | 2015-11-12 |
| Last Update Date | 2015-11-12 |
| Authorized Official Name | CHRISTOPHER DOAN (CHIEF COMPLIANCE COUNSEL) |
| Authorized Official Telephone | 9092354307 |
| Is Organization Subpart | Y |
| Parent Organization Name | PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273Y00000X | Rehabilitation Unit | GA | Hospital Units |
| 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 |
| 1154795581 | Prime Healthcare Foundation - Southern Regional, LLC | Internal Medicine | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2015-11-23 |
| 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 | 273Y00000X |
| Grouping | Hospital Units |
| Classification | Rehabilitation Unit |
| In general, a distinct unit of a general acute care hospital that provides care encompassing a comprehensive array of restoration services for the disabled and all support services necessary to help patients attain their maximum functional capacity. Source: AHA Annual Survey p. A10 1996 AHA Guide. For Medicare, a distinct part of a general acute care hospital providing inpatient rehabilitation services that meets the following requirements. Rehabilitation Units have in effect a preadmission screening procedure under which each prospective patient’s condition and medical history are reviewed to determine whether the patient is likely to benefit significantly from an intensive inpatient program or assessment; ensure that the patients receive close medical supervision and furnish, through the use of qualified personnel, rehabilitation nursing, physical therapy and occupational therapy, plus, as needed, speech therapy, social services or psychological services and orthotic and prosthetic services; have a plan of treatment for each inpatient that is established, reviewed, and revised as needed by a physician in consultation with other professional personnel who provide services to the patient; use a coordinated multidisciplinary team approach in the rehabilitation of each inpatient, as documented by periodic clinical entries made in the patient’s medical record to note the patient's status in relationship to goal attainment, and that team conferences are held at least every two weeks to determine the appropriateness of treatment; have a director of rehabilitation who provides services to the unit and its inpatients for at least 20 hours a week, is a doctor of medicine or osteopathy, is licensed under State law to practice medicine or surgery, and has had, after completing a one-year hospital internship at least two years of training or experience in the medical management of inpatients requiring rehabilitation services. |
| Notes: Source: Code of Federal Regulations #42, Section 412.29. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659416725 | Southern Regional Medical Center, Inc | Rehabilitation Unit | 11 Upper Riverdale Rd Sw, Inpatient Rehab, Riverdale, GA 30274-2615 | 2007-02-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538631437 | Children's Healthcare of Atlanta At Scottish Rite | Rehabilitation Unit | 1400 Tullie Rd Ne Ste 601, Atlanta, GA 30329-2309 | 2018-12-18 |
| 1316456825 | Children's Healthcare of Atlanta At Scottish Rite | Rehabilitation Unit | 605 Big Shanty Road, Nw, Ste 100, Kennesaw, GA 30144-3646 | 2017-09-27 |
| 1386177798 | Southeast Georgia Health Services, L.L.C. | Rehabilitation Unit | 2500 Satilla Pkwy, Waycross, GA 31503-8852 | 2017-04-04 |
| 1578996245 | Complete Healthcare Management LLC | Rehabilitation Unit | 1060 Deer Chase, Stone Mountain, GA 30088-2404 | 2013-08-16 |
| 1306197702 | Children's Healthcare of Atlanta | Rehabilitation Unit | 2270 Duluth Hwy, Duluth, GA 30097-4010 | 2012-09-25 |
| 1497035489 | Body Mechanics Rehabilitation Services, LLC | Rehabilitation Unit | 524 New River Way, Mcdonough, GA 30252-4153 | 2011-08-22 |
| 1598990376 | Phoebe Sumter Medical Center, Inc. | Rehabilitation Unit | 126 Hwy 280 W, Americus, GA 31719-8645 | 2009-05-21 |
| 1124295274 | Va Medical Center-downtown Division/augusta | Rehabilitation Unit | 3336 Thames Pl, Hephzibah, GA 30815-7176 | 2008-05-08 |
| 1942412754 | Calhoun Memorial Hospital | Rehabilitation Unit | 103 R E Jennings Ave, Arlington, GA 39813 | 2007-05-04 |
| 1134168016 | Northside Hospital, Inc. | Rehabilitation Unit | 3215 Mcclure Bridge Rd, Duluth, GA 30096-3223 | 2006-06-06 |
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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.