NPIMap

Organization Active NPI

Curtis V. Cooper Primary Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
National Provider Identifier
1154019248
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Practice address
304 Stephenson Ave
Savannah, GA 31405-5929
Phone
(912) 527-1000
Fax
(912) 527-1155
NPI assigned
Apr 26, 2023
Last updated
Apr 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Authorized official

Name
Earlene Joiner Daniels
Title
Cfo
Phone
(912) 527-1088

Specialties & licenses 1

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

Addresses

Primary practice location

304 Stephenson Ave
Savannah, GA 31405-5929

Mailing address

106 E Broad St
Savannah, GA 31401-2917
Phone (912) 527-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240502000927 GA Part A Provider - Federally Qualified Health Center (FQHC) 4789667015 Practice locations: Savannah, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154019248. Details of each certification follow.

Federally qualified health center certification: CCN C21006

Legal name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 3, 2024
Last certification
May 3, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1981 in GA
Enrollment address
304 Stephenson Ave
Savannah, GA 31405-5929

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory
Tax ID family
Curtis V Cooper Primary Hea16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

2451 Little Neck Rd
Bloomingdale, GA 31302

106 E Broad St
Savannah, GA 31401
Phone (912) 527-1100

3219 College St
Savannah, GA 31404
Phone (912) 358-3439

349 W Bryan St
Savannah, GA 31401
Phone (912) 527-1005

4451 Paulsen St
Savannah, GA 31405
Phone (912) 350-7500

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JDHEAD

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Paul Mosley Individual Corporate DirectorBoard Member Jan 1, 2019
Juliet Wade Individual Corporate DirectorBoard Member Jan 1, 2012
Larry Jackson Individual Corporate DirectorBoard Member Jan 1, 2014
Albert Grandy Individual Corporate DirectorCeo Aug 1, 2013
Earlene J Daniels Individual Corporate OfficerCfo Jan 1, 2018
Corporate DirectorCfo Jan 1, 2014
Operational/Managerial ControlCfo Jan 1, 2020 100%
Helen Stone Individual Corporate DirectorBoard Member Jan 1, 2014
Reginald Franklin Individual Corporate DirectorBoard Member Jan 1, 2012
Mary Hill Individual Corporate DirectorBoard Member Jan 1, 2021

Practitioners & affiliated clinicians

Practitioners 5

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": "1682467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1154019248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 E BROAD ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314012917",
            "telephone_number": "912-527-1100",
            "fax_number": "912-527-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 STEPHENSON AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314055929",
            "telephone_number": "912-527-1000",
            "fax_number": "912-527-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CURTIS V. COOPER PRIMARY HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-26",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "EARLENE",
        "authorized_official_middle_name": "JOINER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "912-527-1088"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.