MACON CARDIOVASCULAR INSTITUTE (NPI# 1104866599) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104866599 |
| Entity Type | Organization |
| Organization Name | MACON CARDIOVASCULAR INSTITUTE |
| Practice Address |
575 1st St Macon GA 31201-2825 |
| Practice Telephone | 4787439762 |
| Practice Fax Number | 4787466612 |
| Mailing Telephone | 4787439762 |
| Mailing Fax Number | 4787466612 |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. LUCY F DERMO (BUSINESS MANAGER) |
| Authorized Official Telephone | 4787439762 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians | ||
| X | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| X | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Street Address |
575 1ST ST |
| City | MACON |
| State | GA |
| Zip Code | 31201-2825 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174502314 | Peter J Bolan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 575 1st St, Macon, GA 31201-2825 | 2006-01-16 |
| 1760948434 | Sandra Bernette Broomfield | Nurse Practitioner | 575 1st St, Macon, GA 31201-2825 | 2019-02-18 |
| 1366988818 | Haley Scruggs | Registered Nurse | 575 1st St, Macon, GA 31201-2825 | 2017-01-09 |
| 1861941775 | Latoia Samson | Physician Assistant | 575 1st St, Macon, GA 31201-2825 | 2016-10-04 |
| 1629438007 | Pamela Carty | Nurse Practitioner | 575 1st St, Macon, GA 31201-2825 | 2016-02-29 |
| 1790153450 | Rhonda Findley | Nurse Practitioner | 575 1st St, Macon, GA 31201-2825 | 2015-09-10 |
| 1801213467 | Jeffrey Brown | Physician Assistant | 575 1st St, Macon, GA 31201-2825 | 2014-03-20 |
| 1285068247 | Christy Rebecca Etheridge | Nurse Practitioner | 575 1st St, Macon, GA 31201-2825 | 2013-08-27 |
| 1295054245 | Melissa C. Mcphail | Nurse Practitioner | 575 1st St, Macon, GA 31201-2825 | 2010-05-28 |
| 1730408063 | Jared Lewis Jarrett | Nurse Practitioner | 575 1st St, Macon, GA 31201-2825 | 2010-05-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639666340 | Yasameen Emad Muzahim | Internal Medicine | 777 Hemlock Street, Msc 165, Macon, GA 31201 | 2018-04-18 |
| 1952819419 | Putnam Dialysis LLC | Clinic/Center | 657 Hemlock Street, Suite 200, Macon, GA 31201 | 2018-01-18 |
| 1730604331 | Graham Arthur Mercier | Surgery | 169 Ashley Ave., Room 202 Main Hospital Msc 333, Charleston, SC 31201 | 2017-08-04 |
| 1376075705 | Diamond Jude | Internal Medicine | 777 Hemlock Street Msc #104, Macon, GA 31201 | 2017-04-03 |
| 1174055263 | Carol Roobin Bashuk | Hearing Instrument Specialist | 634 First Street, Macon, GA 31201 | 2017-03-29 |
| 1144752411 | Hubert Pare | Student in an Organized Health Care Education/Training Program | 777 Hemlock Street, Msc# 165, Macon, GA 31201 | 2017-03-28 |
| 1548613789 | Michael Daugherty | Counselor | 1873 Hardeman Ave, Suite 1, Macon, GA 31201 | 2016-07-22 |
| 1316317993 | 4front Healthcare of Middle Georgia, LLC | Hospice Care, Community Based | 682 1st St, Macon, GA 31201 | 2015-09-25 |
| 1881073054 | Andrew Lee Drahos | Surgery | 777 Hemlock St # 140, Macon, GA 31201 | 2015-05-21 |
| 1720474158 | April Nicole Colley | Nurse Practitioner | 1014 Forsyth Street, Macon, GA 31201 | 2015-04-13 |
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| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174502314 | Peter J Bolan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 575 1st St, Macon, GA 31201-2825 | 2006-01-16 |
| 1861471096 | Fady S Wanna | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 688 Walnut St, Suite 102, Macon, GA 31201 | 2006-01-16 |
| 1902337637 | Premier Cardiothoracic Surgery, LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 688 Walnut St, Suite 102, Macon, GA 31201-2677 | 2017-03-24 |
| 1124062831 | Randall B Brown | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 575 1st St, Macon, GA 31201-2825 | 2006-06-15 |
| 1235172230 | James L Foster Jr. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 575 1st St, Macon, GA 31201-2825 | 2006-06-14 |
| 1194704338 | Laura L Reed | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 688 Walnut St, Ste 200, Macon, GA 31201-2677 | 2006-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437514239 | Tai Iwamura | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4410 Charleston Pl, Dunwoody, GA 30338-6463 | 2015-12-21 |
| 1821330663 | Michael Dory Horowitz | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3465 Harlan Dr Se, Smyrna, GA 30080-4617 | 2013-03-19 |
| 1295075703 | Holland Victor Moore | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 747 Aumond Rd, Augusta, GA 30909-3258 | 2013-02-20 |
| 1376894683 | Agewell Men's Institute | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3596 Old Milton Pkwy, Alpharetta, GA 30005-4465 | 2012-09-26 |
| 1376894709 | Chris Malone, Md | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 740 Prince Ave Ste 13, Athens, GA 30606-5906 | 2012-09-25 |
| 1356602056 | Andrew H Maloney | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 95 Collier Rd Nw Ste 2055, Atlanta, GA 30309-1721 | 2012-05-30 |
| 1134407075 | Robert A Hall Md LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 10 Longfield Ct, Savannah, GA 31410-3513 | 2011-07-26 |
| 1912205964 | Umesh Nareppa | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1365 Clifton Rd Ne Ste A2228, Atlanta, GA 30322-1013 | 2011-02-28 |
| 1174754246 | Adil Sadiq | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1036 Carlyle Lk, Decatur, GA 30033-4632 | 2009-08-06 |
| 1760629216 | Jonathan Gerard Mcguiness | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1365a Clifton Road, Ne, Suite A2223 Cardiothoracic Surgery, Atlanta, GA 30322 | 2009-01-20 |
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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.