MARK SPIVEY ORTHOPEDIC CLINIC, LLC
NPI 1104017821
Orthopaedic Surgery in Vidalia, GA
About Mark Spivey Orthopedic Clinic, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MARK SPIVEY ORTHOPEDIC CLINIC, LLC (NPI 1104017821) is a healthcare organization registered as an orthopaedic surgery in Vidalia, Georgia and active in the NPI registry since August 2007. The organization holds a CLIA Waiver certificate valid through December 19, 2026, maintains 4 additional practice locations, and lists Charles M Spivey, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Secondary Practice Locations 4
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mark Spivey Orthopedic Clinic, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
8Medicare enrollment records show 8 clinicians reassign Medicare billing to Mark Spivey Orthopedic Clinic, LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 5 within 10 miles. They are listed nearest first.
Clinicians, nearest first (8)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 11D2057950
Mark Spivey Orthopedic Clinic · Vidalia, GAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mark Spivey Orthopedic Clinic, LLC's NPI number?
The NPI number for Mark Spivey Orthopedic Clinic, LLC is 1104017821. It was assigned to this organization in the NPPES registry on August 7, 2007.
Where is Mark Spivey Orthopedic Clinic, LLC located?
Mark Spivey Orthopedic Clinic, LLC is located at 3301 E 1st St Ste A, Vidalia, GA 30474. The listed phone number is (912) 537-4411.
What is Mark Spivey Orthopedic Clinic, LLC's specialty?
The primary specialty registered for this NPI is Orthopaedic Surgery with taxonomy code 207X00000X.
Is Mark Spivey Orthopedic Clinic, LLC enrolled in Medicare?
Yes. Mark Spivey Orthopedic Clinic, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Mark Spivey Orthopedic Clinic, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 2 Medicare specialties reassign their Medicare billing to Mark Spivey Orthopedic Clinic, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Orthopedic Surgery (4) and Physical Therapist in Private Practice (4). Of these, 1 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Mark Spivey Orthopedic Clinic, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D2057950) is associated with this NPI, valid through December 19, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Mark Spivey Orthopedic Clinic, LLC accept?
Health plans from Alliant Health Plans, Inc. list Mark Spivey Orthopedic Clinic, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Mark Spivey Orthopedic Clinic, LLC was last updated on June 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mark Spivey Orthopedic Clinic, Llc · NPI 1104017821
Orthopaedic Surgery organization in Vidalia, Georgia. Organization record, active in the CMS NPPES registry since August 7, 2007.
## Identity
- **NPI:** 1104017821 (Entity type: Organization)
- **Enumerated:** August 7, 2007
- **Primary specialty:** Orthopaedic Surgery · taxonomy 207X00000X
- **Also known as:** Mark Spivey Orthopedic Clinic, LLC (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Charles Spivey, OWNER
## Practice location
- **Address:** 3301 E 1ST ST, STE A, Vidalia, GA 30474-8674
- **Phone:** (912) 537-4411 · **Fax:** (912) 538-8485
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 8 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Orthopedic Surgery (4), Physical Therapist in Private Practice (4); 1 practice at this address and 5 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 4, 2026
- **Other identifiers:** Medicaid 501468518E (GA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1104017821) · Data from the CMS NPPES public registry.