NPIMap

Organization Active NPI

Rural Health Care Incorporated

Doing business as Aza Health

  • Federally Qualified Health Center (FQHC)
  • Hawthorne, FL
National Provider Identifier
1114994944
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
22066 SE 71St Avenue
Hawthorne, FL 32640-3969
Phone
(352) 481-2700
Fax
(352) 481-2392
NPI assigned
Mar 1, 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
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Community Health Clinic/Center 261QC1500X L8000011321 FL
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

22066 SE 71St Avenue
Hawthorne, FL 32640-3969

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
029543406MedicaidFL
036741806MedicaidFL
CF6528OtherFLMEDICARE RAILROAD

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
O20031119000927 FL Part A Provider - Federally Qualified Health Center (FQHC) 7214849520 Practice locations: Hawthorne, 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 1114994944. Details of each certification follow.

Federally qualified health center certification: CCN 101941

Legal name
RURAL HEALTH CARE INCORPORATED
Doing business as
AZA HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 30, 2003
Last certification
Dec 30, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1977 in FL
Enrollment address
22066 SE 71St Ave
Hawthorne, FL 32640-3969

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 13

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 Director Sep 29, 2010
Sabrina Thomas Individual Corporate Director Sep 20, 2010
Mary Pipa Individual W-2 Managing EmployeeFinancial Services Supervisor Sep 17, 2010
Elizabeth C Fisher Individual Corporate Director Sep 29, 2010
Laura Spencer Individual Corporate OfficerChief Executive Officer Jun 25, 2010
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 DirectorBoard Member Jan 1, 2013
Constance Schneider Individual Corporate DirectorBoard Member Jan 1, 2020
Selena Fountain Individual Corporate DirectorBoard Member Jan 1, 2024
Robert Germann Individual Corporate DirectorBoard Member Jan 1, 2025
Lashonda Simmons-Watson Individual Corporate Director Sep 20, 2010

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581552000000",
    "number": "1114994944",
    "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": "22066 SE 71ST AVENUE",
            "city": "HAWTHORNE",
            "state": "FL",
            "postal_code": "326403969",
            "telephone_number": "352-481-2700",
            "fax_number": "352-481-2392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH CARE INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-01",
        "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": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "FL",
            "license": "L8000011321",
            "primary": false
        },
        {
            "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": "029543406",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036741806",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CF6528",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aza Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hawthorne, FL

Sources for this page

Verify at the official NPI Registry.