NPIMap

Organization Active NPI

Community Health Care Systems, Inc.

  • Federally Qualified Health Center (FQHC)
  • Tennille, GA
National Provider Identifier
1104876390
Registry record updated Nov 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CARE SYSTEMS, INC.
Practice address
116 Smith St
Tennille, GA 31089-1465
Phone
(478) 552-7384
Fax
(478) 552-1198
NPI assigned
May 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2011

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

Authorized official

Name
Mrs. Lynn W Price
Title
Insurance Supervisor
Phone
(478) 864-3448

Specialties & licenses 1

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

Addresses

Primary practice location

116 Smith St
Tennille, GA 31089-1465

Mailing address

2251 W Elm St
Wrightsville, GA 31096-2017
Phone (478) 864-3448

Other identifiers 2

IdentifierTypeStateIssuer
000521023GMedicaidGA
300029381AMedicaidGA

Other names 1

  • TENNILLE COMMUNITY HEALTH CENTER Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040505000153 GA Part B Supplier - Clinic/Group Practice 5890783179 Receives reassigned benefits from 77 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wrightsville, GA; Wrens, GA; Warrenton, GA; Tennille, GA; Sparta, GA; Sandersville, GA; Milledgeville, GA; Macon, GA…
O20100617000272 GA Part A Provider - Federally Qualified Health Center (FQHC) 5890783179 Practice locations: Tennille, GA

Federally qualified health center certification: CCN 111861

Legal name
COMMUNITY HEALTH CARE SYSTEMS, INC.
Doing business as
TENNILLE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 14, 1999
Last certification
Jun 14, 1999
Ownership / control type
For profit – individual
Organization structure
CorporationNon-profit
Enrollment address
116 Smith St
Tennille, GA 31089-1465

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Other NPIs on the same Medicare enrollment 16

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

View all 16

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
11D0977037Tennille Community Health Center116 South Smith Street, Tennille, GA 31089Provider-performed microscopyMar 17, 2028

National Provider Directory

National Provider Directory

Locations

116 Smith St
Tennille, GA 31089
Phone (478) 552-1620

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Cathy Ivey Individual Corporate Director Jan 1, 1993
Atlean Wilcher Individual Corporate Director Jan 1, 1993
David Montford Individual Corporate OfficerBoard Member Jan 24, 2015
John Williams Individual Corporate Director Jun 1, 2008
Pat Lyons Individual Corporate Director Jan 1, 2007
Mary Cook Individual Corporate Director Jan 1, 1993
Carla Belcher Individual Corporate Director Apr 13, 1998
W-2 Managing Employee Apr 13, 1998

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Community Health Care Systems, Inc-BaldwinMilledgeville, GA, CCN 111022 Federally qualified health center Operational/Managerial Control Sep 1, 2015
Community Health Care Systems, Inc.Macon, GA, CCN 111112 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 22, 2017
May 22, 2017

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321920000000",
    "number": "1104876390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2251 W ELM ST",
            "city": "WRIGHTSVILLE",
            "state": "GA",
            "postal_code": "310962017",
            "telephone_number": "478-864-3448",
            "fax_number": "478-864-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 SMITH ST",
            "city": "TENNILLE",
            "state": "GA",
            "postal_code": "310891465",
            "telephone_number": "478-552-7384",
            "fax_number": "478-552-1198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE SYSTEMS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2011-11-22",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "INSURANCE SUPERVISOR",
        "authorized_official_telephone_number": "478-864-3448",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000521023G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300029381A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TENNILLE COMMUNITY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tennille, GA

Sources for this page

Verify at the official NPI Registry.