NPIMap

Organization Active NPI

Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
National Provider Identifier
1316972599
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC
Practice address
2 Roberts Street
Savannah, GA 31408-3524
Phone
(912) 527-1100
Fax
(912) 527-1153
NPI assigned
Jul 12, 2006
Last updated
Jan 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

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

Authorized official

Name
Earlene Joiner Daniels
Title
Chief Administrative Officer
Phone
(912) 527-1088

Specialties & licenses 1

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

Addresses

Primary practice location

2 Roberts Street
Savannah, GA 31408-3524

Mailing address

106 East Broad Street
Savannah, GA 31401-2917
Phone (912) 527-1000

Other names 1

  • Westside Urban Health Center, Inc Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040609000352 GA Part B Supplier - Clinic/Group Practice 4789667015 Receives reassigned benefits from 77 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Savannah, GA; Prembroke, GA
O20091015000613 GA Part A Provider - Federally Qualified Health Center (FQHC) 4789667015 Practice locations: Savannah, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316972599. Details of each certification follow.

Federally qualified health center certification: CCN 111804

Legal name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1981 in GA
Enrollment address
2 Robert Street
Savannah, GA 31408-3524

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Locations

115 E York St
Savannah, GA 31401
Phone (912) 944-6080

1501 Abercorn St
Savannah, GA 31401
Phone (912) 233-7970

907 E 67th St
Savannah, GA 31405
Phone (912) 352-0129

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Paul Mosley Individual Corporate DirectorBoard Member Jan 1, 2020
Juliet Wade Individual Corporate DirectorBoard Member Jun 1, 2018
Larry Jackson Individual Corporate DirectorBoard Chair Jan 1, 2021
Earlene J Daniels Individual Corporate OfficerCfo Jan 1, 2018
Operational/Managerial ControlCfo Jan 1, 2018
Lester Johnson Individual Corporate DirectorBoard Vice Chair Jan 1, 2019
Roy Devonne Flood Individual Corporate DirectorBoard Member Jan 1, 2017
Mary Hill Individual Corporate DirectorBoard Member Jan 1, 2005
Ray Truitt Individual Corporate DirectorBoard Member Jan 1, 2020
Deborah Wright Individual Corporate DirectorBoard Member Jan 1, 2019

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1316972599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 EAST BROAD STREET",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314012917",
            "telephone_number": "912-527-1000",
            "fax_number": "912-527-1153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 ROBERTS STREET",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314083524",
            "telephone_number": "912-527-1100",
            "fax_number": "912-527-1153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CURTIS V. COOPER PRIMARY HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "EARLENE",
        "authorized_official_middle_name": "JOINER",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "912-527-1088"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westside Urban Health Center, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Westside Urban Health Center, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.