NPIMap

Organization Active NPI

Primary Health Care Center of Dade, Inc.

Doing business as Primary Health Care Center

  • Federally Qualified Health Center (FQHC)
  • Fort Oglethorpe, GA
National Provider Identifier
1255512182
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY HEALTH CARE CENTER OF DADE, INC.
Doing business as
Primary Health Care Center
Practice address
2009 Old Lafayette Rd
Fort Oglethorpe, GA 30742-3510
Phone
(706) 866-5520
Fax
(706) 866-5502
NPI assigned
Nov 20, 2007
Last updated
Sep 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Authorized official

Name
Mrs. Amy L Buffington
Title
Credentialing Coordinator
Phone
(706) 956-2665

Specialties & licenses 1

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

Addresses

Primary practice location

2009 Old Lafayette Rd
Fort Oglethorpe, GA 30742-3510

Mailing address

13570 N Main St
Trenton, GA 30752-2012
Phone (706) 657-7575

Other identifiers 1

IdentifierTypeStateIssuer
000211956CMedicaidGA

Other names 1

  • PRIMARY HEALTH CARE CENTER Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060607000231 GA Part B Supplier - Clinic/Group Practice 0547272650 Receives reassigned benefits from 10 practitioners
12 other NPIs on this enrollment
Practice locations: Summerville, GA; Tunnel Hill, GA; Trenton, GA; Rossville, GA; Ringgold, GA; La Fayette, GA; Fort Oglethorpe, GA
O20080321000168 GA Part A Provider - Federally Qualified Health Center (FQHC) 0547272650 Practice locations: Fort Oglethorpe, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255512182. Details of each certification follow.

Federally qualified health center certification: CCN 111907

Legal name
PRIMARY HEALTH CARE CENTER OF DADE, INC
Doing business as
PRIMARY HEALTH CARE CENTER, ROSSVILLE AT FAIRVIEW
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 21, 2008
Last certification
May 21, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 12, 1981 in GA
Enrollment address
2009 Old Lafayette Rd
Fort Oglethorpe, GA 30742-3510

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Tax ID family
Primary Health Care Center of Dade Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

2009 Old Lafayette Rd
Ph
Fort Oglethorpe, GA 30742

205 Jenkins Rd
Rossville, GA 30741
Phone (706) 866-5520

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
Maritza McKinney Individual Corporate DirectorBoard Member Apr 15, 2026
Kay Henderson Individual Corporate DirectorBoard Member Jul 12, 2024
Susan Wells Individual Corporate DirectorBoard Member Jul 12, 2024
Norman Menard Individual Corporate DirectorBoard Member Apr 15, 2026
Andrew Plisko Individual Corporate DirectorBoard Member Jul 12, 2024
Dale Thomas Dreiling Individual Corporate DirectorBoard Member Apr 15, 2026
Ruben Olm Individual Corporate DirectorBoard Member Apr 15, 2026
Richard Christman Individual Corporate OfficerCeo Apr 15, 2026 100%
Davis Brown Individual Corporate DirectorBoard Member Apr 15, 2026
Michael Caldwell Individual Corporate DirectorBoard Member Apr 15, 2026
Amy Buffington Individual W-2 Managing Employee Jan 1, 2008
Talisyn Ridley Individual Corporate DirectorBoard Member Jul 30, 2021

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Tiger Creek Elementary SchoolTunnel Hill, GA, CCN 111960 Federally qualified health center Other Mar 1, 2013

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 10

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": "1195516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1255512182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13570 N MAIN ST",
            "city": "TRENTON",
            "state": "GA",
            "postal_code": "307522012",
            "telephone_number": "706-657-7575",
            "fax_number": "706-657-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2009 OLD LAFAYETTE RD",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307423510",
            "telephone_number": "706-866-5520",
            "fax_number": "706-866-5502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY HEALTH CARE CENTER OF DADE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-20",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "BUFFINGTON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "706-956-2665",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000211956C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRIMARY HEALTH CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRIMARY HEALTH CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Oglethorpe, GA

Sources for this page

Verify at the official NPI Registry.