Careconnect Health, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Richland, GA
NPI 1063436624 · NPPES record last updated Jan 6, 2020
Key facts
- NPI
- 1063436624
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CARECONNECT HEALTH, INC.
- Practice address
- 510 Alston St Ste B
Richland, GA 31825 - Phone
- (229) 887-3324
- Fax
- (229) 887-3919
- NPI assigned
- Jul 27, 2006
- Reactivated
- May 22, 2007
- Organization subpart
- No
Authorized official
- Name
- Linda Young
- Title
- Secretary
- Phone
- (229) 273-8881
Facilities with the same owner 26
Practitioners 254
-
Taylor Abernathy, CFNP
-
Lekha Udharam Adiani, NP-C
-
Blessing Chinecherem Aroh, MD, MPH, MSC
-
Erin E Babb, FNP
-
Renee Nichols Bailey, FNPC
-
Romana Y Bairan, M.D.
-
Whittnye Barksdale, NP-C
-
Jeremy Beck, MSN, APRN, FNP-C
-
Linsey Brooke Bennett, NP-C
-
Mia Beveridge, NP
-
Parviz Brahman, M.D.
-
Amy Diane Brigman, FNP-C
-
Alan Brown, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2148501 | Pediatric Convenient Care | Certificate of waiver | May 13, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Federally qualified health center certification: CCN 111088
- Legal name
- CARECONNECT HEALTH INC
- Doing business as
- PEDIATRIC CONVENIENT CARE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 15, 2018
- Last certification
- Jun 15, 2018
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 7, 1980 in GA
- Enrollment address
- 1909 US Highway 82 W
Ste 3&4
Tifton, GA 31793-8200
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Walter L. Young |
Corporate Director |
Aug 27, 2020 | 100% |
| Hasmukh Patel |
Corporate Director |
Jul 18, 2023 | 100% |
| Linda S McElroy |
Corporate Director |
Aug 27, 2020 | 100% |
| Rodney Ivey |
Corporate Director |
Jul 18, 2023 | 100% |
| Timothy Buchanan |
Corporate Director |
Aug 27, 2020 | 100% |
| Andrew L Thomas |
Corporate Director |
Aug 27, 2020 | 100% |
| Larry B Smith |
Corporate Director |
Aug 27, 2020 | 100% |
| Ajay S Gehlot |
Corporate Officer | May 2, 2018 | |
| Operational/Managerial Control |
May 2, 2018 | 100% | |
| Other |
May 2, 2018 | 100% | |
| Elizabeth Maddox |
Corporate Director |
Aug 27, 2020 | 100% |
| Joanne M. Jones |
Corporate Director |
Jul 18, 2023 | 100% |
| Careconnect Health Inc |
5% Or Greater Direct Ownership Interest | May 2, 2018 | 100% |
| Operational/Managerial Control | May 2, 2018 | 100% | |
| Sundie M Avery |
Corporate Director |
Oct 22, 2021 | 100% |
| Rhonda J Slocumb |
Corporate Director |
Aug 27, 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 Convenient Care and Pediatrics |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Apr 14, 2020 Apr 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 |
| 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 |
|---|---|---|---|---|
| O20040406001286 | GA | Part B Supplier - Clinic/Group Practice | 7810980794 |
Receives reassigned benefits from 216 practitioners Practice locations: Richland, GA |
| O20180615002430 | GA | Part a Provider - Federally Qualified Health Center (FQHC) | 7810980794 | Practice locations: Tifton, GA |
National Provider Directory
Locations
101 Mayo St
Ste Ab
Americus, GA 31709
Phone (229) 924-4647
712 N 7th St
Cordele, GA 31015
Phone (229) 276-0052
1007 E 16th Ave
Ste A
Cordele, GA 31015
Phone (229) 273-1716
125 McDonald Ave
Cuthbert, GA 39840
Phone (229) 732-3721
23 Old School Rd
Georgetown, GA 39854
Phone (229) 334-9353
1424 N Expressway
Ste 121123
Griffin, GA 30223
Phone (678) 688-2820
259 Broad St
Hawkinsville, GA 31036
Phone (478) 300-7107
1114 GA Highway 96
Ste D3
Kathleen, GA 31047
Phone (478) 910-1090
760 26th Ave SE
Moultrie, GA 31768
Phone (229) 502-9710
510 Alston St
Ste B
Richland, GA 31825
Phone (229) 887-3324
510 Alston St
Richland, GA 31825
Phone (229) 887-3324
636 2nd Ave
Rochelle, GA 31079
Phone (229) 365-2570
1805 Tift Ave N
Ste D
Tifton, GA 31794
Phone (229) 382-5554
1909 US Highway 82 W
Ste 34
Tifton, GA 31793
Phone (229) 445-3509
1909 US Highway 82 W
Ste 4
Tifton, GA 31793
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
510 Alston St Ste B
Richland, GA 31825
Mailing address
510 Alston St Ste B
Richland, GA 31825-6012
Phone (229) 887-3324
Other practice location 1
220 Alston St
Richland, GA 31825-1404
Phone (229) 887-3324
Other providers in Richland, GA
- Wilhelmus Andre Booth II
- Lee Christopher Boyd
- Jacqueline J Burkes
- Careconnect Health, Inc.
- Jacob Michael Colquitt
- Valeisha Faggins
- Four County Health Care LLC
- Four County Health Care, LLC
- Four County Health Care, LLC
All providers in Richland, 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 Jan 6, 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.