NPIMap

Organization Active NPI

Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Atlanta, GA
National Provider Identifier
1053856856
Registry record updated Jun 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MEDCURA HEALTH, INC.
Practice address
2295 Parklake Dr NE
Suite 275
Atlanta, GA 30375-2844
Phone
(404) 298-8998
NPI assigned
Jan 3, 2017
Last updated
Jun 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey Taylor
Title
Ceo
Phone
(404) 298-8998

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X GA Primary

Addresses

Primary practice location

2295 Parklake Dr NE
Suite 275
Atlanta, GA 30375-2844

Mailing address

5582 Memorial Dr
Stone Mountain, GA 30083-3215
Phone (404) 298-8998

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120509000245 GA Part B Supplier - Clinic/Group Practice 2961443643 Receives reassigned benefits from 112 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stone MTN, GA; Stone Mountain, GA; Smyrna, GA; Lithonia, GA; Conyers, GA; Doraville, GA; Decatur, GA; Atlanta, GA…
O20171219000619 GA Part A Provider - Federally Qualified Health Center (FQHC) 2961443643 Practice locations: Atlanta, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053856856. Details of each certification follow.

Federally qualified health center certification: CCN 111076

Legal name
MEDCURA HEALTH, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 19, 2017
Last certification
Dec 19, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1981 in GA
Enrollment address
2295 Parklake Dr NE
Ste 500
Atlanta, GA 30345-2822

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2130751Medcura Health- Northlake2295 Parklake Drive, Suite 500, Atlanta, GA 30345Certificate of waiverJun 27, 2028

National Provider Directory

National Provider Directory
Tax ID family
Medcura Health Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

2295 Parklake Dr NE
Ste 275
Atlanta, GA 30345

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jeffrey Taylor Individual Corporate OfficerCeo Jul 11, 2016 100%
Operational/Managerial ControlCeo Jul 11, 2016

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Medcura Health, IncStone Mountain, GA, CCN 111962 Federally qualified health center Operational/Managerial Control (100%)
Other (100%)		 May 9, 2005
May 9, 2005

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622851200000",
    "number": "1053856856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5582 MEMORIAL DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833215",
            "telephone_number": "404-298-8998",
            "fax_number": "404-298-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2295 PARKLAKE DR NE",
            "address_2": "SUITE 275",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303752844",
            "telephone_number": "404-298-8998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDCURA HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-03",
        "last_updated": "2021-06-05",
        "certification_date": "2021-06-05",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-298-8998"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.