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VIDALIA FAMILY CARE LLC
NPI 1114733250
Clinic/Center - Primary Care in Vidalia, GA

Active since December 04, 2024CLIA 11D2319590 · Waiver
1702 MEADOWS LN, VIDALIA, GA 30474(912) 805-2198(912) 805-2997 Get Directions Write a Review

NPPES record last updated: December 4, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Vidalia Family Care Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VIDALIA FAMILY CARE LLC (NPI 1114733250) is a healthcare organization registered as a primary care in Vidalia, Georgia and active in the NPI registry since December 2024. The organization holds a CLIA Waiver certificate valid through March 3, 2027 and lists John Burton Derrick, Ceo, as its authorized official.

NPPES Registry Identity

NPI1114733250
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameVIDALIA FAMILY CARE LLC
Location Address1702 MEADOWS LNVidalia, GA 30474-7219
Mailing AddressPo Box 645Vidalia, GA 30475-0645 · (912) 293-3308
Phone(912) 805-2198
Fax(912) 805-2997
Organization SubpartNo
Authorized OfficialJohn Burton DerrickCeo · (912) 293-3308
Enumeration DateDecember 4, 2024
NPPES CertifiedDecember 4, 2024
✔ NPI 1114733250 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
1702 MEADOWS LN, Vidalia, GA 30474
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.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)

Vidalia Family Care Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Vidalia Family Care LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Sharifa Abou-Mediene, MD
Internal Medicine
NPI 1750571956
303 FRASER DR
Hinesville, GA 31313
(912) 877-2227
✔ PECOS✔ Accepts Medicare53 mi

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 11D2319590

Vidalia Family Care LLC · Vidalia, GA
Active · expires Mar 3, 2027
CLIA Number11D2319590
Laboratory TypePhysician Office
Certificate Effective DateMarch 4, 2025
Certificate Expiration DateMarch 3, 2027
Laboratory DirectorJohn B. Derrick
Laboratory Phone(912) 805-2198
Laboratory LocationVidalia Family Care LLC1702 Meadows Lane, Vidalia, GA 30474
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently 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 Vidalia Family Care LLC's NPI number?

The NPI number for Vidalia Family Care LLC is 1114733250. It was assigned to this organization in the NPPES registry on December 4, 2024.

Where is Vidalia Family Care LLC located?

Vidalia Family Care LLC is located at 1702 Meadows Ln, Vidalia, GA 30474. The listed phone number is (912) 805-2198.

What is Vidalia Family Care LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Is Vidalia Family Care LLC enrolled in Medicare?

Yes. Vidalia Family Care LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Vidalia Family Care LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Vidalia Family Care 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Vidalia Family Care LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2319590) is associated with this NPI, valid through March 3, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Vidalia Family Care LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Vidalia Family Care 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 Vidalia Family Care LLC was last updated on December 4, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 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.