COLQUITT REGIONAL UROLOGY, LLC
NPI 1215209416
Urology in Moultrie, GA

NPI Status: Active since February 02, 2012

Contact Information

115 31ST AVE SE
MOULTRIE, GA
ZIP 31768
Phone: (229) 891-9148
Fax: (229) 217-4910

NPI Profile Information
Primary Taxonomy
Group Taxonomy
Insurance Plans Accepted
Secondary Locations
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Urology
Accepts Insurance
CLIA Number: 11D2041260
CLIA Cert. Type: Physician Office
CLIA Exp. Date: 05-20-2026

About COLQUITT REGIONAL UROLOGY, LLC

This page provides the complete NPI Profile along with additional information for Colquitt Regional Urology, Llc, a provider established in Moultrie, Georgia operating as a Urology. The healthcare provider is registered in the NPI registry with number 1215209416 assigned on February 2012. The practitioner's primary taxonomy code is 208800000X with license number 67024 (GA). The provider is registered as an organization and their NPI record was last updated 2 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Jayshree Bhavnani (Cfo)

NPI: 1215209416
Provider Name: COLQUITT REGIONAL UROLOGY, LLC
Entity Type: Organization
Location Address: 115 31ST AVE SE MOULTRIE, GA 31768
Location Phone: (229) 891-9148
Location Fax: (229) 217-4910
Mailing Address: PO BOX 2876 MOULTRIE, GA 31776
Mailing Phone: (229) 891-9148
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 02-02-2012
Last Update Date: 08-01-2023
Code Navigator

Location Map

Secondary Locations

16 Live Oak Ct
Moultrie, GA 31768
(229) 891-9148
3131 S Main St
Moultrie, GA 31768
(229) 891-9148

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Urology
Taxonomy Code: 208800000X
Type: Allopathic & Osteopathic Physicians
License No.: 67024
License State: GA
Taxonomy Description: A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Alliant Health Plans, Inc.

SoloCare Bronze EPO HDHP 8050 10004 - EPO
SoloCare Exp Bronze EPO 7200 - $0 Generic Rx 10015 - EPO
SoloCare Gold EPO 2300 - 3 Free PCP Visits, $5 Generic Rx 10010 - EPO
SoloCare Silver EPO 6000/60 - 3 Free PCP Visits 10014 - EPO
SoloCare Silver EPO 7000 - 3 Free PCP Visits, $5 Generic Rx 10013 - EPO
SoloCare Standard Exp Bronze EPO 10008 - EPO
SoloCare Standard Gold EPO 10006 - EPO
SoloCare Standard Platinum EPO 10005 - EPO
SoloCare Standard Silver EPO 10007 - EPO

Ambetter from Absolute Total Care

Clear Silver - HMO
Elite Bronze - HMO
Elite Bronze + Vision + Adult Dental - HMO
Elite Gold - HMO
Elite Gold + Vision + Adult Dental - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO
Everyday Gold - HMO
Everyday Gold + Vision + Adult Dental - HMO
Focused Silver - HMO

Ambetter Health

Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Elite Bronze - HMO
Elite Bronze + Vision + Adult Dental - HMO
Elite Silver - HMO
Elite Silver + Vision + Adult Dental - HMO
Enhanced Diabetes Care Silver with $0 Drug Options - HMO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO

Ambetter of Alabama

Complete Gold - EPO
Complete Gold + Vision + Adult Dental - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Elite Silver - EPO
Elite Silver + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO

Ambetter of North Carolina

Clear Silver with $0 Insulin Options - HMO
Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Complete Gold with Atrium Health - HMO
Complete Gold with Atrium Health + Vision + Adult Dental - HMO
Complete Silver with Atrium Health - HMO
Complete Silver with Atrium Health + Vision + Adult Dental - HMO
Elite Bronze - HMO
Elite Bronze + Vision + Adult Dental - HMO
Elite Bronze with Atrium Health - HMO

Ambetter of Tennessee

Clear Silver - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Enhanced Diabetes Care Silver with $0 Drug Options - EPO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO
Everyday Gold - EPO

WellCare of North Carolina

Standard Expanded Bronze WellCare - PPO
Standard Gold WellCare - PPO
Standard Silver WellCare - PPO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: JAYSHREE BHAVNANI
Authorized Official Title: CFO
Authorized Official Phone: (229) 891-9131

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
202G701316	OTHER (01)	GA	MEDICARE

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 11D2041260
Facility Type: Physician Office
Certificate Effective Date: May 21, 2024
Certificate Expiration Date: May 20, 2026
Laboratory Director: WINSTON W. WILFONG
Certificate Type: Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description: This CLIA certificate is issued to Colquitt Regional Urology, Llc in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	2	1	5	2	0	9	4	1	6
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	2	2	5	4	0	18	4	2
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 2 + 2 + 5 + 4 + 0 + 1 + 8 + 4 + 2 + 24 = 54
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 54 = 6									6

The NPI number 1215209416 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.