1. Home
  2. Directory
  3. Georgia
  4. Waycross
  5. Family Medicine
  6. NPI Profile

ENSIGN FAMILY MEDICINE LLC
NPI 1770224495
Family Medicine in Waycross, GA

Active since April 05, 2022CLIA 11D2265747 · Waiver
1302 PLANT AVE, WAYCROSS, GA 31501(912) 490-5080(912) 490-5081 Get Directions Write a Review

NPPES record last updated: September 28, 2022. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Sep 28, 2022, Apr 5, 2022 (2 updates tracked since 2022).

About Ensign Family Medicine Llc NPPES

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

ENSIGN FAMILY MEDICINE LLC (NPI 1770224495) is a healthcare organization registered as a family medicine in Waycross, Georgia and active in the NPI registry since April 2022. The organization holds a CLIA Waiver certificate valid through August 1, 2028 and lists Shad Stormant, President, as its authorized official.

NPPES Registry Identity

NPI1770224495
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameENSIGN FAMILY MEDICINE LLC
Location Address1302 PLANT AVEWaycross, GA 31501-3537
Mailing Address1302 Plant AveWaycross, GA 31501-3537 · (912) 490-5080
Phone(912) 490-5080
Fax(912) 490-5081
Organization SubpartNo
Authorized OfficialShad StormantPresident · (912) 490-5080
Enumeration DateApril 5, 2022
Last NPPES UpdateSeptember 28, 20222 updates tracked since enumeration
NPPES CertifiedSeptember 28, 2022
✔ NPI 1770224495 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1302 PLANT AVE, Waycross, GA 31501
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ensign Family Medicine 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 Ensign Family Medicine LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Shad Stormant
Family Practice
NPI 1295084374
1302 PLANT AVE
Waycross, GA 31501
(912) 490-5080
✔ PECOS✔ Accepts MedicareSame address

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 11D2265747

Ensign Family Medicine, LLC · Waycross, GA
Active · expires Aug 1, 2028
CLIA Number11D2265747
Laboratory TypePhysician Office
Certificate Effective DateAugust 2, 2026
Certificate Expiration DateAugust 1, 2028
Laboratory DirectorShad A. Stormant
Laboratory Phone(912) 490-5080
Laboratory LocationEnsign Family Medicine, LLC1302 Plant Avenue, Waycross, GA 31501
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 Ensign Family Medicine LLC's NPI number?

The NPI number for Ensign Family Medicine LLC is 1770224495. It was assigned to this organization in the NPPES registry on April 5, 2022.

Where is Ensign Family Medicine LLC located?

Ensign Family Medicine LLC is located at 1302 Plant Ave, Waycross, GA 31501. The listed phone number is (912) 490-5080.

What is Ensign Family Medicine LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Ensign Family Medicine LLC enrolled in Medicare?

Yes. Ensign Family Medicine LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Ensign Family Medicine LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Ensign Family Medicine 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 Ensign Family Medicine LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2265747) is associated with this NPI, valid through August 1, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Ensign Family Medicine LLC was last updated on September 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.