NPIMap

Organization Active NPI

The Sylacauga Health Care Authority

  • Rural Health Clinic/Center
  • Childersburg, AL
National Provider Identifier
1336823632
Registry record updated Jun 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
THE SYLACAUGA HEALTH CARE AUTHORITY
Practice address
33733 US Highway 280
Childersburg, AL 35044-3017
Phone
(256) 378-3301
NPI assigned
Jun 15, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2023

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

Authorized official

Name
Brad McCormick
Title
Chief Financial Officer
Phone
(256) 401-4534

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

33733 US Highway 280
Childersburg, AL 35044-3017

Mailing address

33733 US Highway 280
Childersburg, AL 35044-3017
Phone (256) 378-3301

Other names 1

  • Nix Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230728000658 AL Part A Provider - Rural Health Clinic 5294710398 Practice locations: Childersburg, AL

Rural health clinic certification: CCN 018503

Legal name
THE SYLACAUGA HEALTH CARE AUTHORITY
Doing business as
NIX FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 13, 2023
Last certification
Dec 13, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 20, 1988 in AL
Enrollment address
33733 US Highway 280
Childersburg, AL 35044-3017
Related CCNs
010164

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Sylacauga Hlthcare Auth10 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

33733 US Highway 280
Childersburg, AL 35044
Phone (256) 378-3301

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Jesse L. Cleveland Individual Corporate DirectorBoard Member Jul 1, 2023
Mamoun R Pacha Individual Corporate DirectorBoard Member Jul 1, 2023
Jerry Leonard Fielding Individual Corporate DirectorBoard Member Jul 1, 2023
The Sylacauga Health Care Authority Organization, Sylacauga, AL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2023 100%
Operational/Managerial Control Jul 1, 2023 100%
Stephen R Bowen Individual Corporate DirectorBoard Member Jul 1, 2023
Glenn Chamblee Sisk Individual Corporate OfficerChief Executive Officer Jul 1, 2023
W-2 Managing EmployeeChief Executive Officer Jul 1, 2023
John Floyd Individual Corporate DirectorBoard Member Jul 1, 2023
Shirley Spears Individual Corporate DirectorBoard Member Jul 1, 2023
Wayne Hall Individual Corporate DirectorBoard Member Jul 1, 2023
William McCormick Individual Corporate OfficerChief Financial Officer Jul 1, 2023
W-2 Managing EmployeeChief Financial Officer Jul 1, 2023

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Coosa Valley HospiceSylacauga, AL, CCN 011661 Hospice 5% Or Greater Direct Ownership Interest Mar 8, 2007

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1686787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686873600000",
    "number": "1336823632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33733 US HIGHWAY 280",
            "city": "CHILDERSBURG",
            "state": "AL",
            "postal_code": "350443017",
            "telephone_number": "256-378-3301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33733 US HIGHWAY 280",
            "city": "CHILDERSBURG",
            "state": "AL",
            "postal_code": "350443017",
            "telephone_number": "256-378-3301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SYLACAUGA HEALTH CARE AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-15",
        "last_updated": "2023-06-16",
        "certification_date": "2023-06-16",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "256-401-4534"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nix Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nix Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Childersburg, AL

Sources for this page

Verify at the official NPI Registry.