NPIMap

Organization Active NPI

First Choice Primary Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Warner Robins, GA
National Provider Identifier
1154747590
Registry record updated Mar 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
26859 Issued in GA
Legal business name
FIRST CHOICE PRIMARY CARE, INC.
Practice address
207 Green Street
Warner Robins, GA 31093-2727
Phone
(478) 787-4266
Fax
(478) 787-4199
NPI assigned
Mar 10, 2014
Last updated
Mar 10, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
FIRST CHOICE PRIMARY CARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 10, 2014

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

Authorized official

Name
Mrs. Katherine K McLeod
Title
Ceo
Phone
(478) 254-7223

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 26859 GA Primary

Addresses

Primary practice location

207 Green Street
Warner Robins, GA 31093-2727

Mailing address

PO Box 4363
Macon, GA 31208-4363
Phone (478) 478-4266

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140109001755 GA Part A Provider - Federally Qualified Health Center (FQHC) 6103907316 Practice locations: Warner Robins, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154747590. Details of each certification follow.

Federally qualified health center certification: CCN 111970

Legal name
FIRST CHOICE PRIMARY CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 17, 2014
Last certification
Jan 17, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 27, 2005 in GA
Enrollment address
207 Green Street
Warner Robins, GA 31093-2727

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
First Choice Primary Care Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

100 College Ave SE
Gainesville, GA 30501
Phone (678) 971-5005

174 Walnut St
Macon, GA 31201
Phone 4787874266229

3660 Houston Ave
Macon, GA 31206
Phone 47878742662130

207 Green St
Warner Robins, GA 31093
Phone 4787874266229

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Camille Hope Individual Corporate DirectorBoard Member Jan 1, 2014 10%
Thomas Duval Individual Corporate DirectorBoard Member Jan 1, 2014 10%
David C Parish Individual Corporate DirectorBoard Member Jan 1, 2014 10%
Marvin Riggins Individual Corporate DirectorBoard Member Jan 1, 2014 10%
Jonathan Alderman Individual Corporate DirectorBoard Member Jan 1, 2014 10%
Katherine McLeod Individual Corporate OfficerCeo Jan 1, 2014 10%
Operational/Managerial Control Jan 1, 2014 10%
Linda Holland Individual Corporate DirectorBoard Member Jan 1, 2014 10%
Steven Corkery Individual Corporate DirectorBoard Member Jan 1, 2014 10%
Roz McMillan Individual Corporate DirectorBoard Member Jan 1, 2014 10%
Marc Whitfield Individual Corporate DirectorBoard Member Jan 1, 2014 10%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
First Choice Primary Care, Inc.Macon, GA, CCN 111069 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2007
FCPC Bruce Elementary SBHCMacon, GA, CCN C21039 Federally qualified health center Operational/Managerial Control (100%) May 1, 2025

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 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394409600000",
    "number": "1154747590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4363",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312084363",
            "telephone_number": "478-478-4266",
            "fax_number": "478-787-4199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 GREEN STREET",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310932727",
            "telephone_number": "478-787-4266",
            "fax_number": "478-787-4199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST CHOICE PRIMARY CARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIRST CHOICE PRIMARY CARE, INC.",
        "enumeration_date": "2014-03-10",
        "last_updated": "2014-03-10",
        "status": "A",
        "authorized_official_last_name": "MCLEOD",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "478-254-7223",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "GA",
            "license": "26859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warner Robins, GA

Sources for this page

Verify at the official NPI Registry.