NPIMap

Organization Active NPI

Oconee Valley Healthcare Inc

  • Federally Qualified Health Center (FQHC)
  • Eatonton, GA
National Provider Identifier
1356102198
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OCONEE VALLEY HEALTHCARE INC
Practice address
114 Harmony Xing Ste 5
Eatonton, GA 31024-9546
Phone
(706) 454-1210
Fax
(762) 298-0799
NPI assigned
Jan 18, 2024
Last updated
Mar 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2024

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

Authorized official

Name
Dave Ringer, MDNPI 1992784433
Title
Ceo
Phone
(706) 453-1201

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

114 Harmony Xing Ste 5
Eatonton, GA 31024-9546

Mailing address

803 S Main St
Greensboro, GA 30642-1211
Phone (706) 453-1201

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040604000755 GA Part B Supplier - Clinic/Group Practice 0446232268 Receives reassigned benefits from 26 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Milledgeville, GA; Greensboro, GA; Eatonton, GA
O20240524001381 GA Part A Provider - Federally Qualified Health Center (FQHC) 0446232268 Practice locations: Eatonton, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356102198. Details of each certification follow.

Federally qualified health center certification: CCN C21007

Legal name
OCONEE VALLEY HEALTHCARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 24, 2024
Last certification
May 24, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 22, 2008 in GA
Enrollment address
114 Harmony Crossing
Ste 5
Eatonton, GA 31024-9546

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2297961Oconee Valley Healthcare, Inc114 Harmony Crossing, Suite 5, Eatonton, GA 31024Certificate of waiverJan 24, 2028

National Provider Directory

National Provider Directory

Locations

114 Harmony Xing
Ste D
Eatonton, GA 31024

803 S Main St
Greensboro, GA 30642
Phone (706) 453-1201

510 N Cobb St
Milledgeville, GA 31061
Phone (478) 414-1414

60 GA Highway 22 W
Milledgeville, GA 31061
Phone (478) 414-1414

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Donna Chester Individual Corporate OfficerBoard Member Oct 1, 2006
Rodricus Monford Individual Corporate OfficerBoard Member Oct 1, 2006
Dave a Ringer Individual Corporate DirectorCeo Jun 13, 2013
W-2 Managing Employee Jun 13, 2013
Marc Lhowe Individual Corporate OfficerBoard Member Oct 1, 2006
Morris Miller Individual Corporate OfficerBoard Member Feb 21, 2013
Joan V Antone Individual Corporate OfficerVice Chair Oct 1, 2006
Avis E Williams Individual Corporate OfficerBoard Chair Jan 19, 2006
Linda P McGhee Individual Corporate OfficerSecretary/Treasurer Oct 1, 2006

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
MilledgevilleMilledgeville, GA, CCN 111969 Federally qualified health center Operational/Managerial Control Sep 12, 2013
Oconee Valley Healthcare IncMilledgeville, GA, CCN 111974 Federally qualified health center Operational/Managerial Control (100%) Sep 12, 2013

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1705536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1356102198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 S MAIN ST",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "306421211",
            "telephone_number": "706-453-1201",
            "fax_number": "706-454-0337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 HARMONY XING STE 5",
            "city": "EATONTON",
            "state": "GA",
            "postal_code": "310249546",
            "telephone_number": "706-454-1210",
            "fax_number": "762-298-0799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCONEE VALLEY HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-18",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A",
        "authorized_official_last_name": "RINGER",
        "authorized_official_first_name": "DAVE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-453-1201",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eatonton, GA

Sources for this page

Verify at the official NPI Registry.