| Sjc Medical Group Inc | |
|
527 Eisenhower Dr Savannah GA 31406-2668 | |
| (912) 819-9100 | |
| (912) 819-9100 |
| Full Name | Sjc Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 527 Eisenhower Dr, Savannah, Georgia |
| Authorized Official Name and Position | Donna J Stephens (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 9128197878 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sjc Medical Group Inc 602 E 72nd St Savannah GA 31405-4913 Ph: (912) 819-7878 | Sjc Medical Group Inc 527 Eisenhower Dr Savannah GA 31406-2668 Ph: (912) 819-9100 |
| NPI Number | 1811233828 |
|---|---|
| Provider Enumeration Date | 12/19/2012 |
| Last Update Date | 01/23/2017 |
| Medicare PECOS PAC ID | 7719978105 |
|---|---|
| Medicare Enrollment ID | O20040524000690 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811233828 | NPI | - | NPPES |
| Provider Name | Amanda H Cowan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912948589 PECOS PAC ID: 0547166878 Enrollment ID: I20031209000306 |
| Provider Name | Roger G Branch |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568482644 PECOS PAC ID: 3678469160 Enrollment ID: I20040223000789 |
| Provider Name | James Harrington |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265503635 PECOS PAC ID: 0941190888 Enrollment ID: I20040316000970 |
| Provider Name | David A Valbuena |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1528071198 PECOS PAC ID: 0941282156 Enrollment ID: I20040602000886 |
| Provider Name | Jacqueline A Caffrey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063434165 PECOS PAC ID: 3678559812 Enrollment ID: I20040628000873 |
| Provider Name | Lorraine M Mcrae |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912928912 PECOS PAC ID: 4880671288 Enrollment ID: I20040702000884 |
| Provider Name | Joenie T Almeida |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447271333 PECOS PAC ID: 1557349966 Enrollment ID: I20040712001213 |
| Provider Name | Lisa Ann Bozik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831206382 PECOS PAC ID: 3476512955 Enrollment ID: I20041008001190 |
| Provider Name | Martin L Mcroberts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982625075 PECOS PAC ID: 7214997527 Enrollment ID: I20041012000811 |
| Provider Name | Lawrence F Zottoli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184788812 PECOS PAC ID: 2860459989 Enrollment ID: I20041210000117 |
| Provider Name | Kenneth M Eugene |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801950530 PECOS PAC ID: 4082671110 Enrollment ID: I20041210000168 |
| Provider Name | James M Mcneely |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598829863 PECOS PAC ID: 7113984279 Enrollment ID: I20041210000398 |
| Provider Name | Thomas J Ferrari |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346249109 PECOS PAC ID: 1557325438 Enrollment ID: I20050121000528 |
| Provider Name | Steven K Corse |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750320073 PECOS PAC ID: 2860446721 Enrollment ID: I20050303000813 |
| Provider Name | Francisco Fantauzzi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821161688 PECOS PAC ID: 0648225888 Enrollment ID: I20050321000523 |
| Provider Name | Jay Schecter |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1871658054 PECOS PAC ID: 3577594746 Enrollment ID: I20060112000954 |
| Provider Name | Felicia M Carr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205858750 PECOS PAC ID: 5890798623 Enrollment ID: I20060817000302 |
| Provider Name | Suzanne M Anderson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528012895 PECOS PAC ID: 6103850227 Enrollment ID: I20061031000432 |
| Provider Name | Steven Greer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326136714 PECOS PAC ID: 6103843743 Enrollment ID: I20061108000581 |
| Provider Name | Frederic C Spector |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1114906286 PECOS PAC ID: 9234130428 Enrollment ID: I20070131000373 |
| Provider Name | Roger W Beville |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154435550 PECOS PAC ID: 0143322370 Enrollment ID: I20070219000614 |
| Provider Name | John E Hartmann |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1982694998 PECOS PAC ID: 1153427109 Enrollment ID: I20070508000264 |
| Provider Name | Jacqueline M Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518989078 PECOS PAC ID: 1052419470 Enrollment ID: I20070608000358 |
| Provider Name | Richard J Barrett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538194634 PECOS PAC ID: 6507949559 Enrollment ID: I20080213000695 |
| Provider Name | Jignesh R Dholaria |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104019181 PECOS PAC ID: 1557423563 Enrollment ID: I20081230000329 |
| Provider Name | Marianne M Fleming |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750323879 PECOS PAC ID: 3870633688 Enrollment ID: I20091229000282 |
| Provider Name | Jose M Rendon-garcia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083650972 PECOS PAC ID: 1557405578 Enrollment ID: I20100215000331 |
| Provider Name | Karen Elaine Turner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700937174 PECOS PAC ID: 0446330559 Enrollment ID: I20101020001457 |
| Provider Name | Theresa E Montoya-houser |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982650883 PECOS PAC ID: 2062429343 Enrollment ID: I20110110000880 |
| Provider Name | Irwin G Streiff |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447220298 PECOS PAC ID: 3375732118 Enrollment ID: I20110111000239 |
| Provider Name | Russell William Lake |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104081082 PECOS PAC ID: 7911187125 Enrollment ID: I20110204000650 |
| Provider Name | Teresa U Cayton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366731234 PECOS PAC ID: 1254516024 Enrollment ID: I20110421000549 |
| Provider Name | Hugh Dorsey Flanders |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1710916333 PECOS PAC ID: 9739356031 Enrollment ID: I20120126000482 |
| Provider Name | James L Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134149313 PECOS PAC ID: 2961669130 Enrollment ID: I20120131000810 |
| Provider Name | Keith A Rouse |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1558374124 PECOS PAC ID: 1759357767 Enrollment ID: I20120202000466 |
| Provider Name | Mihaela Saler |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1083876759 PECOS PAC ID: 1658528229 Enrollment ID: I20120904000692 |
| Provider Name | Jean M Bailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376896670 PECOS PAC ID: 2668624438 Enrollment ID: I20121203000066 |
| Provider Name | Shannon Stewart |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1144482803 PECOS PAC ID: 8820239593 Enrollment ID: I20130723000037 |
| Provider Name | Jill P Trumble |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1437311180 PECOS PAC ID: 4880837269 Enrollment ID: I20130904000587 |
| Provider Name | Kathleen Flynn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528497500 PECOS PAC ID: 0446480974 Enrollment ID: I20140303001422 |
| Provider Name | Traiana D Pacurar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811986003 PECOS PAC ID: 8224097829 Enrollment ID: I20140630000793 |
| Provider Name | Brian S Raj |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1508182981 PECOS PAC ID: 1951529718 Enrollment ID: I20140820001939 |
| Provider Name | Jeffrey P Borkoski |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1518947498 PECOS PAC ID: 8224014907 Enrollment ID: I20140822000181 |
| Provider Name | Jonas A Vanags |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245474048 PECOS PAC ID: 7012136260 Enrollment ID: I20140919001594 |
| Provider Name | Carlos M Victorica |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396945648 PECOS PAC ID: 0648354340 Enrollment ID: I20150109001630 |
| Provider Name | James R Poston |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1427372986 PECOS PAC ID: 8325276322 Enrollment ID: I20150709002383 |
| Provider Name | Marc L Wilkinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770543837 PECOS PAC ID: 1850436536 Enrollment ID: I20160711001279 |
| Provider Name | Leslie Pittman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013245091 PECOS PAC ID: 5890003578 Enrollment ID: I20160818002209 |
| Provider Name | Heidi Ann Sullivan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295188498 PECOS PAC ID: 7416237094 Enrollment ID: I20161219000549 |
| Provider Name | Kara Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386183879 PECOS PAC ID: 3870870413 Enrollment ID: I20170508001806 |
| Provider Name | Samuel M Hall |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1568881498 PECOS PAC ID: 8325338064 Enrollment ID: I20170803000723 |
| Provider Name | Melanie Mooney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861462970 PECOS PAC ID: 1759369747 Enrollment ID: I20180702000426 |
| Provider Name | Russell H Pacquette |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447568597 PECOS PAC ID: 3274768015 Enrollment ID: I20180821002572 |
| Provider Name | Knar Mesrobian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124412317 PECOS PAC ID: 4183974892 Enrollment ID: I20180829004820 |
| Provider Name | Frederick Harold |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629484902 PECOS PAC ID: 9638492341 Enrollment ID: I20180907002637 |
| Provider Name | Caitlin C Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669989000 PECOS PAC ID: 8921359779 Enrollment ID: I20180918003699 |
| Provider Name | Aaron Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013465681 PECOS PAC ID: 4587908124 Enrollment ID: I20181207001564 |
| Provider Name | Matthew Groce Marshall |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1124462403 PECOS PAC ID: 5294049664 Enrollment ID: I20181220001848 |
| Provider Name | Harley Randall Hendrix |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003265836 PECOS PAC ID: 3779871207 Enrollment ID: I20191014001661 |
| Provider Name | Prianka Sharma |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1407207046 PECOS PAC ID: 2860724358 Enrollment ID: I20191104000030 |
| Provider Name | Carolyn Ann Nelson |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1285021626 PECOS PAC ID: 1355639964 Enrollment ID: I20200811004135 |
| Provider Name | Andrew Mrugala |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1518316207 PECOS PAC ID: 9436447331 Enrollment ID: I20200812000412 |
| Provider Name | Tia C Bingham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043645229 PECOS PAC ID: 0547549974 Enrollment ID: I20201001000995 |
| Provider Name | Thomas Brance Falace |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326539131 PECOS PAC ID: 0749525491 Enrollment ID: I20210804003191 |
| Provider Name | Kimberly Brown |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1821754490 PECOS PAC ID: 3779973250 Enrollment ID: I20211124002233 |
| Provider Name | Brittany Olivo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912339466 PECOS PAC ID: 4880084136 Enrollment ID: I20211201001093 |
| Provider Name | Andrew Carney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861921868 PECOS PAC ID: 0749551554 Enrollment ID: I20220302001936 |
| Provider Name | Christie Lynn Phillips-fearis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629579578 PECOS PAC ID: 3678835253 Enrollment ID: I20220901000962 |
| Provider Name | Jennifer Leigh Kirkman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023455136 PECOS PAC ID: 0840416145 Enrollment ID: I20230130000989 |
| Provider Name | Priti Nath |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1861789422 PECOS PAC ID: 0143549188 Enrollment ID: I20230926002462 |
| Provider Name | Robert N Brackenrich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215559687 PECOS PAC ID: 2961825971 Enrollment ID: I20231218001680 |
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