NPIMap

Organization Active NPI

Christ Community Health Services Augusta, Inc

  • Federally Qualified Health Center (FQHC)
  • Augusta, GA
National Provider Identifier
1073192985
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHRIST COMMUNITY HEALTH SERVICES AUGUSTA, INC
Practice address
2604 Peach Orchard Rd Ste 200
Augusta, GA 30906-2406
Phone
(706) 922-0600
NPI assigned
Apr 7, 2021
Last updated
Jul 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Authorized official

Name
Mrs. Ursula Shanerra Rosa
Title
Credentialing & Privileging Manager
Phone
(706) 922-0600

Specialties & licenses 1

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

Addresses

Primary practice location

2604 Peach Orchard Rd Ste 200
Augusta, GA 30906-2406

Mailing address

PO Box 31164
Augusta, GA 30903-2964

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080401000769 GA Part B Supplier - Clinic/Group Practice 6608953633 Receives reassigned benefits from 32 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Augusta, GA
O20210708000207 GA Part A Provider - Federally Qualified Health Center (FQHC) 6608953633 Practice locations: Augusta, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073192985. Details of each certification follow.

Federally qualified health center certification: CCN 111146

Legal name
CHRIST COMMUNITY HEALTH SERVICES AUGUSTA, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 28, 2021
Last certification
Jun 28, 2021
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Aug 1, 2006 in GA
Enrollment address
2604 Peach Orchard Rd
Ste 200
Augusta, GA 30906-2406

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

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
11D2229253Christ Community Health Services2604 Peach Orchard Rd Suite 200, Augusta, GA 30906Provider-performed microscopyJul 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Christ Comm Health Serv6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1238 Dantignac St
#D
Augusta, GA 30901

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Johnie Tillman Individual Corporate DirectorBoard Chair Feb 28, 2022
Jacqueline C Heider Individual Corporate DirectorBoard Member Mar 24, 2025
Michael Amos Meyers Individual Corporate DirectorBoard Member Apr 22, 2024
Ursula Shanerra Rosa Individual W-2 Managing EmployeeCredentialing and Privileging Manag Jan 1, 2024
Christie a Densmore Individual Corporate OfficerCfo Feb 1, 2025
W-2 Managing EmployeeCfo Feb 1, 2025
Robert a Campbell Individual W-2 Managing EmployeeMD; Nov 1, 2007
Willie Jerome Jackson Individual Corporate OfficerCeo Apr 14, 2025
W-2 Managing EmployeeCeo Apr 14, 2025
Elisabeth Conrad Becton Individual Corporate DirectorBoard Vice Chair Mar 24, 2025
Alicia B Elam Individual Corporate DirectorBoard Member Apr 22, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Christ Community Health Services Augusta, Inc.Augusta, GA, CCN 111953 Federally qualified health center Operational/Managerial Control Jul 1, 2007
Christ Community Health Services Augusta, Inc.Augusta, GA, CCN 111954 Federally qualified health center Operational/Managerial Control Jul 1, 2007
Christ Community Health Services Augusta, Inc.Augusta, GA, CCN 851168 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2007

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 27

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.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753660800000",
    "number": "1073192985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31164",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309032964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 PEACH ORCHARD RD STE 200",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309062406",
            "telephone_number": "706-922-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRIST COMMUNITY HEALTH SERVICES AUGUSTA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-07",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A",
        "authorized_official_last_name": "ROSA",
        "authorized_official_first_name": "URSULA",
        "authorized_official_middle_name": "SHANERRA",
        "authorized_official_title_or_position": "CREDENTIALING & PRIVILEGING MANAGER",
        "authorized_official_telephone_number": "706-922-0600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.