NPIMap

Careconnect Health, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Butler, GA

NPI 1104255934 · NPPES record last updated Jan 3, 2020

Key facts

NPI
1104255934
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
CARECONNECT HEALTH, INC.
Practice address
80 W Main St
Butler, GA 31006-5156
Phone
(478) 862-5453
Fax
(478) 862-5454
NPI assigned
Nov 2, 2013
Organization subpart
No

Authorized official

Name
Linda Young
Title
Secretary
Phone
(229) 273-8881

Corporate family (same tax ID) 18

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2069394Careconnect Family Practice
80 West Main Street, Butler, GA 31006		Certificate of waiverNov 24, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Federally qualified health center certification: CCN 111973

Legal name
CARECONNECT HEALTH INC
Doing business as
CARECONNECT FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 4, 2014
Last certification
Mar 4, 2014
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Nov 7, 1980 in GA
Enrollment address
80 W Main St
Butler, GA 31006-5156

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Walter L. Young
Individual 		Corporate Director
Board Member		 Jan 8, 2014 100%
Hasmukh Patel
Individual 		Corporate Director
Board Member		 Jul 7, 2023 100%
Linda S McElroy
Individual 		Corporate Director
Board Member		 Jan 8, 2014 100%
Rodney Ivey
Individual 		Corporate Director
Board Member		 Jul 7, 2023 100%
Timothy Buchanan
Individual 		Corporate Director
Board Member		 Jul 21, 2020 100%
Andrew L Thomas
Individual 		Corporate Director
Board Member		 Jan 8, 2014 100%
Larry B Smith
Individual 		Corporate Director
Board Member		 Jan 8, 2014 100%
Ajay S Gehlot
Individual 		Corporate Director
Ceo		 Jul 21, 2020 100%
W-2 Managing Employee
Ceo		 Jan 8, 2014 100%
Elizabeth Maddox
Individual 		Corporate Director
Board Member		 Jul 21, 2020 100%
Joanne M. Jones
Individual 		Corporate Director
Board Member		 Jul 7, 2023 100%
Sundie M Avery
Individual 		Corporate Director
Board Member		 Sep 1, 2021 100%
Rhonda J Slocumb
Individual 		Corporate Director
Board Member		 Jul 21, 2020 100%

All facility ownership & control disclosures 27

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

FacilityTypeRoleSince
Americus Urgent Care
Americus, GA · CCN 111925		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 21, 2016
May 14, 2020
Careconnect Family Practice
Cordele, GA · CCN 111932		 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
Eastman, GA · CCN 111933		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 14, 2020
Apr 14, 2020
Careconnect Family Practice
Cochran, GA · CCN 111935		 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
Americus, GA · CCN 111942		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 21, 2020
Jul 21, 2020
Americus OBGYN
Americus, GA · CCN 111986		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 17, 2016
Jul 22, 2020
Careconnect Pediatrics
Montezuma, GA · CCN 111001		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 27, 2017
Jul 22, 2020
Careconnect Urgent Care
Moultrie, GA · CCN 111019		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 20, 2018
May 16, 2023
Careconnect Convenient Care
Ellaville, GA · CCN 111027		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 20, 2015
Jul 23, 2020
Careconnect Convenient Care
Thomaston, GA · CCN 111020		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 9, 2015
Jul 14, 2023
Careconnect Convenient Care
Hawkinsville, GA · CCN 111029		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 9, 2022
Feb 1, 2016
Pediatric Urgent Care
Cordele, GA · CCN 111039		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 10, 2016
May 10, 2016
New Hope Clinic
Cordele, GA · CCN 111054		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 10, 2017
Jan 10, 2017
Careconnect Convenient Care
Perry, GA · CCN 111055		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 9, 2017
Careconnect Family Practice and Pediatrics
Ashburn, GA · CCN 111056		 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 13, 2017
Careconnect Convenient Care
Tifton, GA · CCN 111080		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 6, 2017
Jun 9, 2017
Careconnect Convenient Care
Cuthbert, GA · CCN 111079		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 19, 2017
Jun 19, 2017
Careconnect Pediatrics
Cordele, GA · CCN 111068		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 20, 2017
Jul 20, 2017
Careconnect Urgent Care
Griffin, GA · CCN 111071		 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control (100%)		 Jul 1, 2017
Jul 1, 2017
Careconnect Convenient Care
Fort Valley, GA · CCN 111082		 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
Tifton, GA · CCN 111088		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 2, 2018
May 2, 2018
Careconnect Pediatrics
Moultrie, GA · CCN 111094		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 26, 2018
Jul 26, 2018
Careconnect Family Practice
Alamo, GA · CCN 111102		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 21, 2018
Sep 21, 2018
Careconnect Convenient Care
Griffin, GA · CCN 111099		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 19, 2018
Nov 19, 2018
Careconnect Convenient Care
Dawson, GA · CCN 851053		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 11, 2021
May 11, 2021
Pediatric Convenient Care
Kathleen, GA · CCN 851163		 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Feb 17, 2022
Feb 17, 2022
New Hope Clinic
Americus, GA · CCN 851164		 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 IDStateProvider typePAC IDDetails
O20140225000925 GA Part a Provider - Federally Qualified Health Center (FQHC) 7810980794 Practice locations: Butler, GA

National Provider Directory

Tax ID family
Careconnect Health Inc (51 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

80 W Main St
Butler, GA 31006-5156

Mailing address

80 W Main St
Butler, GA 31006-5156
Phone (478) 862-5453

Other names

  • CareConnect Family Practice Doing business as

Other providers in Butler, GA

All providers in Butler, GA · Federally Qualified Health Center (FQHC) in Georgia

Sources for this page

Verify at the official NPI Registry.