Center for Pan Asian Community Services, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Peachtree Corners, GA
NPI 1336493311 · NPPES record last updated Mar 27, 2023
Key facts
- NPI
- 1336493311
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CENTER FOR PAN ASIAN COMMUNITY SERVICES, INC.
- Practice address
- 6185 Buford Hwy BLDG B
Peachtree Corners, GA 30071-2350 - Phone
- (770) 936-0969
- NPI assigned
- Oct 30, 2012
- Organization subpart
- No
Authorized official
- Name
- Mrs. Chaiwon Kim
- Title
- Chief Executive Officer
- Phone
- (770) 936-0969
Other NPIs on the same Medicare enrollment 1
Practitioners 5
-
Deema Elchoufi, MD
-
Marianne Lissade, AGNP-C
-
Sandra T Seaton, LCSW
-
Jong K Song, M.D.
-
Amitha Sampath, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in GA
Federally qualified health center certification: CCN 111008
- Legal name
- CENTER FOR PAN ASIAN COMMUNITY SERVICES, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 20, 2015
- Last certification
- Jun 20, 2015
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 1, 1983 in GA
- Enrollment address
- 6185 Buford Hwy
BLDG G
Norcross, GA 30071-2350
Federally qualified health center certification: CCN 111107
- Legal name
- CENTER FOR PAN ASIAN COMMUNITY SERVICES, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 6, 2019
- Last certification
- Feb 6, 2019
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 6185 Bufford Hwy
Building a
Norcross, GA 30071
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Elba Ramos-Algarin |
Corporate Director |
Jan 1, 2023 | |
| Kelly Kim |
Corporate Director |
Jan 1, 2023 | |
| Robert T Williams |
Corporate Director |
Jan 1, 2023 | |
| Anthony Roark |
Corporate Director |
Jan 1, 2023 | |
| Erin Chun |
Corporate Director |
Jan 1, 2023 | |
| Yenny Feliz |
Corporate Director |
Jan 1, 2023 | |
| Christopher Harrison Smith |
Corporate Director |
Jan 1, 2023 | |
| Misoon Lee |
Corporate Director |
Jan 1, 2023 | |
| Corporate Officer |
Mar 7, 2019 | ||
| Alexis U Nkusi |
Corporate Officer |
Mar 18, 2024 | |
| W-2 Managing Employee | Mar 18, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140827000843 | GA | Part B Supplier - Clinic/Group Practice | 1355569765 |
Receives reassigned benefits from 4 practitioners Practice locations: Norcross, GA |
| O20150620000049 | GA | Part a Provider - Federally Qualified Health Center (FQHC) | 1355569765 | Practice locations: Norcross, GA |
| O20190307003235 | GA | Part a Provider - Federally Qualified Health Center (FQHC) | 1355569765 |
1 other NPI on this enrollment Practice locations: Norcross, GA |
National Provider Directory
Locations
3510 Shallowford Rd NE
Chamblee, GA 30341
Phone (770) 936-0969
6185 Buford Hwy
Peachtree Corners, GA 30071
Phone (770) 446-0929
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/BFAGCA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
6185 Buford Hwy BLDG B
Peachtree Corners, GA 30071-2350
Mailing address
3510 Shallowford Rd NE
Atlanta, GA 30341-2909
Phone (770) 936-0969
Other names
- CPACS-Cosmo Health Center
Other providers in Peachtree Corners, GA
- Carter Treatment Center
- Kathleen A Casey
- Michael J. Cattell
- CCSD-PC, LLC
- Cedar Dental Clinical I, LLC
- Center for Pan Asian Community Services, Inc.
- Center for Pan Asian Community Services, Inc.
- Center for Pan Asian Community Services, Inc.
- Ritu Chadha
- Kittiya Chaiyachati
All providers in Peachtree Corners, GA · Federally Qualified Health Center (FQHC) in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.