NPIMap

Organization Active NPI

Community Health Care Systems, Inc.

Doing business as Tricounty Health Systems-Gibson

  • Federally Qualified Health Center (FQHC)
  • Gibson, GA
National Provider Identifier
1245400969
Registry record updated Mar 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CARE SYSTEMS, INC.
Doing business as
Tricounty Health Systems-Gibson
Practice address
702 West Main St
Gibson, GA 30810-4135
Phone
(706) 598-3359
Fax
(706) 598-3403
NPI assigned
Mar 10, 2008
Last updated
Mar 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2016

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

Authorized official

Name
Carla W Belcher
Title
Ceo
Phone
(478) 552-7384

Specialties & licenses 1

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

Addresses

Primary practice location

702 West Main St
Gibson, GA 30810-4135

Mailing address

PO Box 371
Wrightsville, GA 31096-0371
Phone (478) 864-3448

Other names 1

  • TRICOUNTY HEALTH SYSTEMS-GIBSON Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040505000153 GA Part B Supplier - Clinic/Group Practice 5890783179 Receives reassigned benefits from 77 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wrightsville, GA; Wrens, GA; Warrenton, GA; Tennille, GA; Sparta, GA; Sandersville, GA; Milledgeville, GA; Macon, GA…
O20141117000132 GA Part A Provider - Federally Qualified Health Center (FQHC) 5890783179 Practice locations: Gibson, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245400969. Details of each certification follow.

Federally qualified health center certification: CCN 111003

Legal name
COMMUNITY HEALTH CARE SYSTEMS, INC.
Doing business as
TRICOUNTY HEALTH SYSTEM-GIBSON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 17, 2014
Last certification
Nov 17, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 9, 1992 in GA
Enrollment address
702 W Main St
Gibson, GA 30810-4014

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Johnson Co Center for Comm20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Cathy Ivey Individual Corporate DirectorChairperson Jan 1, 1993
Atlean Wilcher Individual Corporate DirectorBoard Member Jan 1, 1993
David Montford Individual Corporate DirectorBoard Member Dec 17, 2012
John Williams Individual Corporate DirectorBoard Member Jun 1, 2008
Pat Lyons Individual Corporate DirectorBoard Member Jan 1, 2007
Mary Cook Individual Corporate DirectorBoard Member Jan 1, 1993
Carla Belcher Individual Corporate DirectorCeo Apr 13, 1998
W-2 Managing EmployeeCeo Apr 13, 1998

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Community Health Care Systems, Inc-BaldwinMilledgeville, GA, CCN 111022 Federally qualified health center Operational/Managerial Control Sep 1, 2015
Community Health Care Systems, Inc.Macon, GA, CCN 111112 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 22, 2017
May 22, 2017

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1205107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456876800000",
    "number": "1245400969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 371",
            "city": "WRIGHTSVILLE",
            "state": "GA",
            "postal_code": "310960371",
            "telephone_number": "478-864-3448",
            "fax_number": "478-864-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 WEST MAIN ST",
            "city": "GIBSON",
            "state": "GA",
            "postal_code": "308104135",
            "telephone_number": "706-598-3359",
            "fax_number": "706-598-3403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE SYSTEMS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-10",
        "last_updated": "2016-03-02",
        "status": "A",
        "authorized_official_last_name": "BELCHER",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "478-552-7384"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRICOUNTY HEALTH SYSTEMS-GIBSON",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gibson, GA

Sources for this page

Verify at the official NPI Registry.