NPIMap

Organization Active NPI

Rural Health Care Incorporated

Doing business as Aza Health

  • Federally Qualified Health Center (FQHC)
  • Keystone Heights, FL
National Provider Identifier
1073589065
Registry record updated Feb 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL HEALTH CARE INCORPORATED
Doing business as
Aza Health
Practice address
100 Commercial Dr
Keystone Heights, FL 32656-6802
Phone
(352) 473-6595
Fax
(352) 473-6597
NPI assigned
Feb 28, 2006
Last updated
Feb 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2020

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

Authorized official

Name
Laura M. Spencer
Title
Chief Executive Officer
Phone
(386) 328-0108

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Community Health Clinic/Center 261QC1500X L800009980 FL
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

100 Commercial Dr
Keystone Heights, FL 32656-6802

Mailing address

1302 River St
Palatka, FL 32177-5042
Phone (386) 328-0108

Other identifiers 4

IdentifierTypeStateIssuer
DE2912OtherFLMEDICARE RAILROAD
026423790MedicaidFL
029543405MedicaidFL
037641805MedicaidFL

Other names 1

  • Aza Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031106000304 FL Part A Provider - Federally Qualified Health Center (FQHC) 7214849520 Practice locations: Keystone Heights, FL
O20031219000375 FL Part B Supplier - Clinic/Group Practice 7214849520 Receives reassigned benefits from 82 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Keystone Heights, FL; Welaka, FL; St Augustine, FL; Palm Coast, FL; Palatka, FL; Interlachen, FL; Hawthorne, FL; Hasting, FL…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073589065. Details of each certification follow.

Federally qualified health center certification: CCN 101919

Legal name
RURAL HEALTH CARE INCORPORATED
Doing business as
AZA HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 23, 1996
Last certification
Dec 23, 1996
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1977 in FL
Enrollment address
100 Commercial Dr
Keystone Heights, FL 32656-6802
Related CCNs
101843

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Kathy L Dean Individual Corporate DirectorDirector Sep 29, 2010
Sabrina Thomas Individual Corporate Director Sep 20, 2010
Mary Pipa Individual W-2 Managing Employee Sep 17, 2010
Elizabeth C Fisher Individual Corporate DirectorDirector Sep 29, 2010
Laura Spencer Individual Corporate Director Jun 25, 2010
W-2 Managing Employee Jun 25, 2010
Joseph Giacomo Individual Corporate OfficerChief Financial Officer May 20, 2019
W-2 Managing EmployeeChief Financial Officer May 20, 2019
Donavan Bardier Individual Corporate DirectorBoard Member Jan 1, 2024
Lucia Valdivia-Sanchez Individual Corporate DirectorBoard Member Jan 28, 2019
Moses a Floyd Individual Corporate DirectorDirector Jan 1, 2013
Constance Schneider Individual Corporate DirectorBoard Member Jan 1, 2020
Lashonda Simmons-Watson Individual Corporate Director Sep 20, 2010

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581552000000",
    "number": "1073589065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 RIVER ST",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321775042",
            "telephone_number": "386-328-0108",
            "fax_number": "386-325-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COMMERCIAL DR",
            "city": "KEYSTONE HEIGHTS",
            "state": "FL",
            "postal_code": "326566802",
            "telephone_number": "352-473-6595",
            "fax_number": "352-473-6597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH CARE INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-28",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "386-328-0108"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "FL",
            "license": "L800009980",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DE2912",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026423790",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029543405",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "037641805",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aza Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Keystone Heights, FL

Sources for this page

Verify at the official NPI Registry.