NPIMap

Organization Active NPI

Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Decatur, GA
National Provider Identifier
1245010347
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MEDCURA HEALTH, INC.
Practice address
2162 Second Ave
Decatur, GA 30032-5259
Phone
(404) 298-8998
NPI assigned
Oct 5, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Authorized official

Name
Billie Inclan
Title
HR
Phone
(404) 564-9345

Specialties & licenses 1

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

Addresses

Primary practice location

2162 Second Ave
Decatur, GA 30032-5259

Mailing address

770 Village Square Dr
Stone Mountain, GA 30083-3380

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120509000245 GA Part B Supplier - Clinic/Group Practice 2961443643 Receives reassigned benefits from 112 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stone MTN, GA; Stone Mountain, GA; Smyrna, GA; Lithonia, GA; Conyers, GA; Doraville, GA; Decatur, GA; Atlanta, GA…
O20231102001099 GA Part A Provider - Federally Qualified Health Center (FQHC) 2961443643 Practice locations: Decatur, GA

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Federally qualified health center certification: CCN 851988

Legal name
MEDCURA HEALTH, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 1, 2023
Last certification
Nov 1, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1981 in GA
Enrollment address
2162 Second Ave
Decatur, GA 30032-5259

National Provider Directory

National Provider Directory
Tax ID family
Oakhurst Comm HLTH Cent15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

1706 Candler Rd
Decatur, GA 30032

5582 Memorial Dr
Stone Mountain, GA 30083
Phone (404) 513-9965

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Jeffrey Taylor Individual Corporate OfficerCeo Oct 2, 2023 100%
Operational/Managerial ControlCeo Oct 2, 2023 100%

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Medcura Health, IncStone Mountain, GA, CCN 111962 Federally qualified health center Operational/Managerial Control (100%)
Other (100%)		 May 9, 2005
May 9, 2005

Owned or controlled facilities with NPI records 1

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

Other NPIs on the same Medicare enrollment 13

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

View all 13

Practitioners 18

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

View all 18

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
11D2298786Medcura Health Inc2162 2ND Avenue, Decatur, GA 30032Certificate of waiverFeb 7, 2028

NPI Registry JSON

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

{
    "created_epoch": "1696464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1245010347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 VILLAGE SQUARE DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2162 SECOND AVE",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300325259",
            "telephone_number": "404-298-8998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDCURA HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-05",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-03",
        "status": "A",
        "authorized_official_last_name": "INCLAN",
        "authorized_official_first_name": "BILLIE",
        "authorized_official_title_or_position": "HR",
        "authorized_official_telephone_number": "404-564-9345"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

Verify at the official NPI Registry.