Primary Health Care Center of Dade, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Trenton, GA
NPI 1437102449 · NPPES record last updated Jan 21, 2019
Key facts
- NPI
- 1437102449
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- PRIMARY HEALTH CARE CENTER OF DADE, INC.
- Practice address
- 13570 N Main St
Trenton, GA 30752-2012 - Phone
- (706) 956-2665
- Fax
- (706) 657-5885
- NPI assigned
- May 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Linda S Nixon, CFO
- Title
- Chief Financial Officer
- Phone
- (706) 657-7575
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 12
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 9
Practitioners 14
-
William L Horton, DO
-
Felix D Cruz, LPC
-
Haley Catanzarito Jones, LCSW
-
Jaime C Bingham, APN
-
Courtney Elyse Cummings, PSY.D.
-
Kaci J Floyd, NP-C
-
Gayoung Hong, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0673616 | Primary Health Care Center of Dade, Inc | Certificate of waiver | Oct 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Federally qualified health center certification: CCN 111815
- Legal name
- PRIMARY HEALTH CARE CENTER OF DADE, INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 1, 1992
- Last certification
- Aug 1, 1992
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 21, 1981 in GA
- Enrollment address
- 13570 N Main St
Trenton, GA 30752-2012
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Maritza McKinney |
Corporate Director |
Apr 15, 2026 | |
| Kay Henderson |
Corporate Director |
Jul 12, 2024 | |
| Susan Wells |
Corporate Director |
Jul 12, 2024 | |
| Norman Menard |
Corporate Director |
Apr 15, 2026 | |
| Andrew Plisko |
Corporate Director |
Jul 12, 2024 | |
| Dale Thomas Dreiling |
Corporate Director |
Apr 15, 2026 | |
| Ruben Olm |
Corporate Director |
Apr 15, 2026 | |
| Richard Christman |
W-2 Managing Employee |
Apr 15, 2026 | 100% |
| Davis Brown |
Corporate Director |
Apr 15, 2026 | |
| Michael Caldwell |
Corporate Director |
Apr 15, 2026 | |
| Amy Buffington |
Corporate Director |
Jun 11, 2010 | 100% |
| W-2 Managing Employee | Jun 11, 2010 | ||
| Talisyn Ridley |
Corporate Director |
Jul 30, 2021 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Tiger Creek Elementary School |
Federally qualified health center | Other | Mar 1, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060607000231 | GA | Part B Supplier - Clinic/Group Practice | 0547272650 |
Receives reassigned benefits from 10 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Summerville, GA; Tunnel Hill, GA; Trenton, GA; Rossville, GA; Ringgold, GA; La Fayette, GA; Fort Oglethorpe, GA |
| O20100623000972 | GA | Part a Provider - Federally Qualified Health Center (FQHC) | 0547272650 | Practice locations: Trenton, GA |
National Provider Directory
- Tax ID family
- Primary Health Care Center of Dade Inc
Locations
13570 N Main St
Ph
Trenton, GA 30752
Interoperability endpoints
- andrew.combs@gadirect.net
- donna.van.schuyver@gadirect.net
- jaime.harris1@gadirect.net
- gayoung.hong@gadirect.net
- jose.justiniano.ayala@gadirect.net
- kaci.floyd1@gadirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
13570 N Main St
Trenton, GA 30752-2012
Mailing address
13570 N Main St
Trenton, GA 30752-2012
Phone (706) 657-7575
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10057286 | Other | GA | AMERIGROUP (GA MEDICAID) |
| 336412 | Other | GA | WELLCARE (GA MEDICAID MCO |
| 000211956A | Medicaid | GA |
Other providers in Trenton, GA
- Taylor Peters
- Physical Therapy Associates of Chattanooga, Inc.
- Ponder Pharmacy Inc
- Premiere Senior Care, LLC
- Price Pharmacy Inc
- Red Rock Dental
- George Burton Reed III
- Laura Ellen Robinson
- Lindsay Michelle Ryan
- Ritaben Darshit Shah
All providers in Trenton, 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 Jan 21, 2019. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.