VIDALIA IMMEDIATE & PRIMARY CARE LLC
NPI 1942974167
Clinic/Center - Primary Care in Vidalia, GA
About Vidalia Immediate & Primary Care Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
VIDALIA IMMEDIATE & PRIMARY CARE LLC (NPI 1942974167) is a healthcare organization registered as a primary care in Vidalia, Georgia and active in the NPI registry since August 2021. The organization holds a CLIA Waiver certificate valid through May 9, 2028 and lists Melissa Ann Beckum, Practice Manager/office Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Vidalia Immediate & Primary Care Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
9Medicare enrollment records show 9 clinicians reassign Medicare billing to Vidalia Immediate & Primary Care LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 4 within 10 miles. They are listed nearest first.
Clinicians, nearest first (9)
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 11D2259716
Vidalia Immediate And Primary Care · 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 Vidalia Immediate & Primary Care LLC's NPI number?
The NPI number for Vidalia Immediate & Primary Care LLC is 1942974167. It was assigned to this organization in the NPPES registry on August 2, 2021.
Where is Vidalia Immediate & Primary Care LLC located?
Vidalia Immediate & Primary Care LLC is located at 122 Alice Coleman Drive, Vidalia, GA 30474. The listed phone number is (912) 805-2273.
What is Vidalia Immediate & Primary Care LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Vidalia Immediate & Primary Care LLC enrolled in Medicare?
Yes. Vidalia Immediate & Primary Care LLC is registered in the Medicare PECOS enrollment system.
When is Vidalia Immediate & Primary Care LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Georgia, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Vidalia Immediate & Primary Care LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 9 clinicians in 3 Medicare specialties reassign their Medicare billing to Vidalia Immediate & Primary 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. The largest specialties are Nurse Practitioner (6), Family Practice (2) and Emergency Medicine (1). Of these, 2 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Vidalia Immediate & Primary Care LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D2259716) is associated with this NPI, valid through May 9, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Vidalia Immediate & Primary 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 Immediate & Primary 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 Immediate & Primary Care LLC was last updated on November 16, 2021. 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.
# Vidalia Immediate & Primary Care Llc · NPI 1942974167
Primary Care organization in Vidalia, Georgia. Organization record, active in the CMS NPPES registry since August 2, 2021.
## Identity
- **NPI:** 1942974167 (Entity type: Organization)
- **Enumerated:** August 2, 2021
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Melissa Beckum, PRACTICE MANAGER/OFFICE MANAGER
## Practice location
- **Address:** 122 ALICE COLEMAN DRIVE, Vidalia, GA 30474
- **Phone:** (912) 805-2273
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, Georgia, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 9 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (6), Family Practice (2), Emergency Medicine (1); 2 practice at this address and 4 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 16, 2021
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1942974167) · Data from the CMS NPPES public registry.