Southeast Georgia Physician Associates – Clinic/Center, NPI 1417979402
Clinic/Center
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Southeast Georgia Physician Associates
2415 PARKWOOD DR
BRUNSWICK, GA 315204722
Phone: (912) 466-7000
Fax: (912) 466-5091
Type: Location
Southeast Georgia Health System, 2415, Parkwood Drive, Brunswick, Glynn County, Georgia, 31520, United States
BRUNSWICK, GA 315204722
Phone: (912) 466-7000
Fax: (912) 466-5091
Type: Mailing
Gable Oaks Court, Leland, Brunswick County, North Carolina, United States
BRUNSWICK, GA 315256738
Phone: (912) 466-5400
Fax: (912) 267-4749
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2026-03-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 9 Medicare enrollment records; no due dates published yet.
Enrollment records
9
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20031124000222 | O | Clinic/Group Practice | GA | TBD |
| O20251120001063 | O | Clinic/Group Practice | FL | TBD |
| O20251210004245 | O | Clinic/Group Practice | IL | TBD |
| O20251212002248 | O | Clinic/Group Practice | CA | TBD |
| O20251212002643 | O | Clinic/Group Practice | VA | TBD |
| O20251216002572 | O | Clinic/Group Practice | PA | TBD |
| O20251218002214 | O | Clinic/Group Practice | TX | TBD |
| O20251222003281 | O | Clinic/Group Practice | MO | TBD |
| O20260313003088 | O | Clinic/Group Practice | MA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 31520)
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