1ST SOURCE HEALTHCARE (NPI# 1841664695) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841664695 |
| Entity Type | Organization |
| Organization Name | 1ST SOURCE HEALTHCARE |
| Practice Address |
534 Ivy Brook Way Macon GA 31210-4049 |
| Practice Telephone | 4789720748 |
| Mailing Telephone | 4789720748 |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2015-11-17 |
| Authorized Official Name | MICHAEL BRANDON LUCAS (ADMINISTRATOR) |
| Authorized Official Telephone | 4789720748 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251E00000X | Home Health | Agencies |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | 1ST SOURCE HEALTHCARE | 534 Ivy Brook Way, Macon, GA 31210-4049 |
| Street Address |
534 IVY BROOK WAY |
| City | MACON |
| State | GA |
| Zip Code | 31210-4049 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033743455 | Dana Elizabeth Toth | Nurse Practitioner | 5300 Bowman Rd, Macon, GA 31210 | 2020-02-25 |
| 1871124735 | Jessica Bello | Nurse Practitioner | 5300 Bowman Road, Macon, GA 31210 | 2020-01-30 |
| 1225505787 | Rebekah Hollinshead | Occupational Therapist | Therapy Specialists of Georgia, 4116 Arkwright Road, Macon, GA 31210 | 2018-11-01 |
| 1346744943 | Ace Medical Transport LLC. | Ambulance | 728 Gay Dr, Macon, GA 31210 | 2018-03-20 |
| 1972965226 | Omar Faruk Ahmad | Family Medicine | 3400 Riverside Drvie, Macon, GA 31210 | 2016-03-25 |
| 1083074868 | Macon Dentist Office, PC | Dentist | 206 Tom Hill Sr Blvd, Suite 106, Macon, GA 31210 | 2016-03-07 |
| 1992176952 | Kerisia Wasztyl | Marriage & Family Therapist | 4691 Pine Valley Dr, Macon, GA 31210 | 2015-10-15 |
| 1073905444 | Eunice Malave De Leon | Social Worker | 174 Spring St, Macon, GA 31210 | 2015-02-23 |
| 1396141545 | Axis Surgery Center LLC | Clinic/Center | 230 Sheraton Blvd, Ste B, Macon, GA 31210 | 2014-11-17 |
| 1073914115 | Monique Rechelle Delay Moore | Community/Behavioral Health | 646 Millrun Court, Macon, GA 31210 | 2014-09-09 |
| Find all providers in zip 31210 | ||||
| Taxonomy Code | 251E00000X |
| Grouping | Agencies |
| Classification | Home Health |
| A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. |
| Notes: Source: CFR42 Chapter IV Part 484, http://www.access.gpo.gov/nara/cfr/waisidx_99/42cfr484_99.html [7/1/2007: definition added, source added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245861434 | Erika Jones Thomas | Home Health | 5120 Nisbet Dr, Macon, GA 31206-4724 | 2020-01-28 |
| 1528604857 | Southern Home Care Services, Inc. | Home Health | 105 Preston Ct Ste B, Macon, GA 31210-5769 | 2019-11-21 |
| 1366085466 | Abundant Care Services, LLC | Home Health | 125 Plantation Centre Dr S Ste 500b, Macon, GA 31210-2087 | 2019-10-21 |
| 1750946901 | Rebecca Bogle | Home Health | 311 Juniper Ln, Macon, GA 31220-7642 | 2019-05-03 |
| 1093291668 | Tyler Rashad Thomas | Home Health | 351 Amanda Dr, Macon, GA 31216-6387 | 2018-07-17 |
| 1003337718 | Shantha Tyhessia Jones | Home Health | 2453 Shea Drive, Macon, GA 31206 | 2017-07-03 |
| 1619497757 | First Choice Home Health & Behavioral Services LLC | Home Health | 4038 Suzanne Dr, Macon, GA 31204-3738 | 2017-06-20 |
| 1780058537 | Abundant Health Care Agency | Home Health | 109 Madison North Dr, Macon, GA 31220-7627 | 2015-11-17 |
| 1639545098 | Tranquillity Home Care, LLC | Home Health | 154 Mcgee St, Macon, GA 31204-2308 | 2015-08-19 |
| 1871913145 | Amazing Grace Home Care Services, Inc | Home Health | 2449 Vineville Ave Ste 7, Macon, GA 31204-2955 | 2014-04-24 |
| 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.