NPIMap

Organization Active NPI

Primary Health Care Center of Dade, Inc.

  • Federally Qualified Health Center (FQHC)
  • Trenton, GA
National Provider Identifier
1437102449
Registry record updated Jan 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Jan 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2019

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

Authorized official

Name
Linda S Nixon, CFO
Title
Chief Financial Officer
Phone
(706) 657-7575

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437102449. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Feb 21, 1981 in GA
Enrollment address
13570 N Main St
Trenton, GA 30752-2012

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 12

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
11D0673616Primary Health Care Center of Dade, Inc13570 North Main Street, Trenton, GA 30752Certificate of waiverOct 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Primary Health Care Center of Dade Inc10 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

13570 N Main St
Ph
Trenton, GA 30752

Interoperability endpoints

  • Direct secure messaging: andrew.combs@gadirect.net
  • Direct secure messaging: donna.van.schuyver@gadirect.net
  • Direct secure messaging: gayoung.hong@gadirect.net
  • Direct secure messaging: jaime.harris1@gadirect.net
  • Direct secure messaging: jose.justiniano.ayala@gadirect.net
  • Direct secure messaging: kaci.floyd1@gadirect.net

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Maritza McKinney Individual Corporate DirectorBoard Member Apr 15, 2026
Kay Henderson Individual Corporate DirectorBoard Member Jul 12, 2024
Susan Wells Individual Corporate DirectorBoard Member Jul 12, 2024
Norman Menard Individual Corporate DirectorBoard Member Apr 15, 2026
Andrew Plisko Individual Corporate DirectorBoard Member Jul 12, 2024
Dale Thomas Dreiling Individual Corporate DirectorBoard Member Apr 15, 2026
Ruben Olm Individual Corporate DirectorBoard Member Apr 15, 2026
Richard Christman Individual W-2 Managing EmployeeAd; Apr 15, 2026 100%
Davis Brown Individual Corporate DirectorBoard Member Apr 15, 2026
Michael Caldwell Individual Corporate DirectorBoard Member Apr 15, 2026
Amy Buffington Individual Corporate DirectorCredentialing Director Jun 11, 2010 100%
W-2 Managing Employee Jun 11, 2010
Talisyn Ridley Individual Corporate DirectorBoard Member Jul 30, 2021

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Tiger Creek Elementary SchoolTunnel Hill, GA, CCN 111960 Federally qualified health center Other Mar 1, 2013

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548028800000",
    "number": "1437102449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13570 N MAIN ST",
            "city": "TRENTON",
            "state": "GA",
            "postal_code": "307522012",
            "telephone_number": "706-657-7575",
            "fax_number": "706-657-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13570 N MAIN ST",
            "city": "TRENTON",
            "state": "GA",
            "postal_code": "307522012",
            "telephone_number": "706-956-2665",
            "fax_number": "706-657-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY HEALTH CARE CENTER OF DADE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2019-01-21",
        "status": "A",
        "authorized_official_last_name": "NIXON",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "706-657-7575",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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 Trenton, GA

Sources for this page

Verify at the official NPI Registry.