NPIMap

Organization Active NPI

Georgia Highlands Medical Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Cumming, GA
National Provider Identifier
1174529192
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GEORGIA HIGHLANDS MEDICAL SERVICES, INC.
Practice address
260 Elm St
Cumming, GA 30040-2467
Phone
(770) 887-1668
Fax
(770) 781-9937
NPI assigned
Jun 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Todd Shifflet
Title
Ceo
Phone
(770) 887-1668

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X GA Primary
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

260 Elm St
Cumming, GA 30040-2467

Mailing address

PO Box 307
Cumming, GA 30028-0307
Phone (770) 887-1668

Other identifiers 2

IdentifierTypeStateIssuer
000192574CMedicaidGA
300022400AMedicaidGA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040302001307 GA Part B Supplier - Clinic/Group Practice 5890682017 Receives reassigned benefits from 26 practitioners
7 other NPIs on this enrollment
Practice locations: Canton, GA; Dawsonville, GA; Cumming, GA; Cartersville, GA; Buford, GA
O20100604000195 GA Part A Provider - Federally Qualified Health Center (FQHC) 5890682017 Practice locations: Cumming, GA

Federally qualified health center certification: CCN 111838

Legal name
GEORGIA HIGHLANDS MEDICAL SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1997
Last certification
Jan 1, 1997
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1979 in GA
Enrollment address
260 Elm St
Cumming, GA 30040-2467

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Locations

210 Oakside Ln
Ste C
Canton, GA 30114
Phone (770) 704-1955

Interoperability endpoints

  • Direct secure messaging: arif.patni@gadirect.net
  • Direct secure messaging: beatrice.von.zeschau.wilder@gadirect.net
  • Direct secure messaging: faye.spector@gadirect.net
  • Direct secure messaging: swapna.madhavan@gadirect.net
  • Direct secure messaging: brinkley.goodson@gadirect.net

Ownership & related parties

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
Elba Montalvo-Torres Individual Corporate DirectorBoard Secretary Sep 1, 2016
Gary Riggs Individual Corporate DirectorBoard Treasurer Jun 21, 2016
Todd Shifflet Individual Corporate OfficerCeo Apr 13, 2015
W-2 Managing EmployeeCeo Apr 13, 2015
Cheryl Cagle Individual Corporate DirectorBoard Member Nov 1, 2016
Jesann Hendrix Individual Corporate DirectorBoard Member Sep 1, 1996
Karen Denise Cox Individual W-2 Managing EmployeeCredentialing Specialist Sep 22, 2014
Donald Fortenberry Individual Corporate DirectorBoard Member Nov 1, 2016
Stephen Brown Individual Corporate OfficerCfo Apr 19, 2017
W-2 Managing EmployeeCfo Apr 19, 2017
Elizabeth Garcia Individual Corporate DirectorBoard Member Nov 1, 2016
Ruth Baumann Individual Corporate DirectorBoard President Elect Sep 1, 2016
David Keith Pruitt Individual Corporate DirectorBoard President Sep 1, 2016
Gina Santos Individual Corporate DirectorBoard Member May 18, 2010

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Georgia Highlands Medical Services, Inc.Cumming, GA, CCN 111195 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2022

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1174529192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 307",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300280307",
            "telephone_number": "770-887-1668",
            "fax_number": "770-781-9937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 ELM ST",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300402467",
            "telephone_number": "770-887-1668",
            "fax_number": "770-781-9937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA HIGHLANDS MEDICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2022-07-21",
        "certification_date": "2022-05-09",
        "status": "A",
        "authorized_official_last_name": "SHIFFLET",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-887-1668",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "GA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000192574C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300022400A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.