Careconnect Health, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Eastman, GA
NPI 1043440340 · NPPES record last updated Mar 31, 2020
Key facts
- NPI
- 1043440340
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CARECONNECT HEALTH, INC.
- Practice address
- 817 Griffin Ave
Eastman, GA 31023-6718 - Phone
- (478) 374-1801
- Fax
- (478) 448-4586
- NPI assigned
- Jul 21, 2009
- Organization subpart
- No
Authorized official
- Name
- Linda Young
- Title
- Secretary
- Phone
- (229) 273-8881
Corporate family (same tax ID) 14
Facilities with the same owner 26
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D1103404 | Careconnect Convenient Care and Pediatrics | Certificate of waiver | Aug 10, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Federally qualified health center certification: CCN 111933
- Legal name
- CARECONNECT HEALTH INC
- Doing business as
- CARECONNECT CONVENIENT CARE AND PEDIATRICS
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 23, 2010
- Last certification
- Mar 23, 2010
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 7, 1980 in GA
- Enrollment address
- 817 Griffin Ave
Eastman, GA 31023-6718
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Walter L. Young |
Corporate Director |
Nov 8, 2012 | 100% |
| Hasmukh Patel |
Corporate Director |
Jul 7, 2023 | 100% |
| Linda S McElroy |
Corporate Director |
Nov 8, 2012 | 100% |
| Rodney Ivey |
Corporate Director |
Nov 18, 2022 | 100% |
| Timothy Buchanan |
Corporate Director |
Apr 14, 2020 | 100% |
| Andrew L Thomas |
Corporate Director |
Nov 8, 2012 | 100% |
| Larry B Smith |
Corporate Director |
Nov 8, 2012 | 100% |
| Ajay S Gehlot |
Corporate Director |
Jul 17, 2020 | 100% |
| W-2 Managing Employee |
Jul 17, 2020 | 100% | |
| Elizabeth Maddox |
Corporate Director |
Apr 14, 2020 | 100% |
| Joanne M. Jones |
Corporate Director |
Jul 7, 2023 | 100% |
| Careconnect Health Inc |
5% Or Greater Direct Ownership Interest | Apr 14, 2020 | 100% |
| Operational/Managerial Control | Apr 14, 2020 | 100% | |
| Sundie M Avery |
Corporate Director |
Aug 6, 2021 | 100% |
| Rhonda J Slocumb |
Corporate Director |
Apr 14, 2020 | 100% |
All facility ownership & control disclosures 26
| Facility | Type | Role | Since |
|---|---|---|---|
| Americus Urgent Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jun 21, 2016 May 14, 2020 |
| Careconnect Family Practice |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
May 14, 2020 May 14, 2020 |
| Careconnect Family Practice |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) Other (100%) |
Jun 25, 2020 Jun 25, 2020 Jun 25, 2020 |
| Careconnect Family Dentistry |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jul 21, 2020 Jul 21, 2020 |
| Americus OBGYN |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jun 17, 2016 Jul 22, 2020 |
| Careconnect Pediatrics |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Apr 27, 2017 Jul 22, 2020 |
| Careconnect Urgent Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jul 20, 2018 May 16, 2023 |
| Careconnect Convenient Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jul 20, 2015 Jul 23, 2020 |
| Careconnect Convenient Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Sep 9, 2015 Jul 14, 2023 |
| Careconnect Convenient Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Aug 9, 2022 Feb 1, 2016 |
| Pediatric Urgent Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
May 10, 2016 May 10, 2016 |
| New Hope Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 10, 2017 Jan 10, 2017 |
| Careconnect Convenient Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Feb 9, 2017 |
| Careconnect Family Practice and Pediatrics |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Feb 13, 2017 |
| Careconnect Convenient Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jun 6, 2017 Jun 9, 2017 |
| Careconnect Convenient Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jun 19, 2017 Jun 19, 2017 |
| Careconnect Pediatrics |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jul 20, 2017 Jul 20, 2017 |
| Careconnect Urgent Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest Operational/Managerial Control (100%) |
Jul 1, 2017 Jul 1, 2017 |
| Careconnect Convenient Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) Other (100%) |
Jan 19, 2018 Jan 19, 2018 Jan 19, 2018 |
| Pediatric Convenient Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
May 2, 2018 May 2, 2018 |
| Careconnect Pediatrics |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jul 26, 2018 Jul 26, 2018 |
| Careconnect Family Practice |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Sep 21, 2018 Sep 21, 2018 |
| Careconnect Convenient Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Nov 19, 2018 Nov 19, 2018 |
| Careconnect Convenient Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
May 11, 2021 May 11, 2021 |
| Pediatric Convenient Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Feb 17, 2022 Feb 17, 2022 |
| New Hope Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Feb 23, 2022 Feb 23, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100318000882 | GA | Part a Provider - Federally Qualified Health Center (FQHC) | 7810980794 | Practice locations: Eastman, GA |
National Provider Directory
- Tax ID family
- Careconnect Health Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
817 Griffin Ave
Eastman, GA 31023-6718
Mailing address
P.O. Box 5610
Cordele, GA 31010-1514
Phone (229) 273-8881
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 312980311A | Medicaid | GA |
Other names
- CareConnect Convenient Care and Pediatrics
Other providers in Eastman, GA
- Jennifer Elizabeth Brown
- Pamela Lynn Brown
- Kristen Nicole Bryant
- Ashley Nichole Butler
- Randy James Cammack
- Robert Todd Carey
- Clark M Carroll
- Chandler Womens Health Center
- Zachary Bryan Chaney
- Joe Franklin Chapman
All providers in Eastman, GA · Federally Qualified Health Center (FQHC) in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.