NPIMap

Organization Active NPI

Careconnect Health, Inc.

Doing business as Pediatric Convenient Care

  • Federally Qualified Health Center (FQHC)
  • Kathleen, GA
National Provider Identifier
1447833926
Registry record updated May 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CARECONNECT HEALTH, INC.
Doing business as
Pediatric Convenient Care
Practice address
1114 Ga Highway 96 Ste D3-D5
Kathleen, GA 31047-2111
Phone
(478) 910-1090
Fax
(478) 910-1091
NPI assigned
May 3, 2021
Last updated
May 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2022

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

Authorized official

Name
Linda Young
Title
Executive Secretary
Phone
(229) 273-8881

Specialties & licenses 1

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

Addresses

Primary practice location

1114 Ga Highway 96 Ste D3-D5
Kathleen, GA 31047-2111

Mailing address

PO Box 5610
Cordele, GA 31010-5610
Phone (229) 273-8881

Other names 1

  • Pediatric Convenient Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220421000322 GA Part A Provider - Federally Qualified Health Center (FQHC) 7810980794 Practice locations: Kathleen, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447833926. Details of each certification follow.

Federally qualified health center certification: CCN 851163

Legal name
CARECONNECT HEALTH INC
Doing business as
PEDIATRIC CONVENIENT CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 21, 2022
Last certification
Mar 21, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 7, 1980 in GA
Enrollment address
1114 Ga Highway 96
Ste D3-D5
Kathleen, GA 31047-2111

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
11D2226422Pediatric Convenient Care1114 Ga Hwy 96, Suite D3 - D5, Kathleen, GA 31047Certificate of waiverMay 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Southwest Georgia Hlthcare51 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1114 GA Highway 96
Unit 1315
Kathleen, GA 31047

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Walter L. Young Individual Corporate DirectorBoard Member Feb 17, 2022 100%
Hasmukh Patel Individual Corporate DirectorBoard Member Jul 7, 2023 100%
Linda S McElroy Individual Corporate DirectorBoard Member Feb 17, 2022 100%
Rodney Ivey Individual Corporate DirectorBoard Member Jul 7, 2023 100%
Timothy Buchanan Individual Corporate DirectorBoard Member Feb 17, 2022 100%
Andrew L Thomas Individual Corporate DirectorBoard Member Feb 17, 2022 100%
Larry B Smith Individual Corporate DirectorBoard Member Feb 17, 2022 100%
Ajay S Gehlot Individual Corporate DirectorCeo Feb 17, 2022 100%
W-2 Managing EmployeeCeo Feb 17, 2022 100%
Elizabeth Maddox Individual Corporate DirectorBoard Member Feb 17, 2022 100%
Joanne M. Jones Individual Corporate DirectorBoard Member Jul 7, 2023 100%
Careconnect Health Inc Organization, Cordele, GA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Feb 17, 2022
Operational/Managerial Control Feb 17, 2022
Sundie M Avery Individual Corporate DirectorBoard Member Feb 17, 2022 100%
Rhonda J Slocumb Individual Corporate DirectorBoard Member Feb 17, 2022 100%

All facility ownership & control disclosures 26

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

FacilityTypeRoleSince
Americus Urgent CareAmericus, GA, CCN 111925 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 21, 2016
May 14, 2020
Careconnect Family PracticeCordele, GA, CCN 111932 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 14, 2020
May 14, 2020
Careconnect Convenient Care and PediatricsEastman, GA, CCN 111933 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 14, 2020
Apr 14, 2020
Careconnect Family PracticeCochran, GA, CCN 111935 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Other (100%)		 Jun 25, 2020
Jun 25, 2020
Jun 25, 2020
Careconnect Family DentistryAmericus, GA, CCN 111942 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 21, 2020
Jul 21, 2020
Americus OBGYNAmericus, GA, CCN 111986 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 17, 2016
Jul 22, 2020
Careconnect PediatricsMontezuma, GA, CCN 111001 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 27, 2017
Jul 22, 2020
Careconnect Urgent CareMoultrie, GA, CCN 111019 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 20, 2018
May 16, 2023
Careconnect Convenient CareEllaville, GA, CCN 111027 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 20, 2015
Jul 23, 2020
Careconnect Convenient CareThomaston, GA, CCN 111020 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 9, 2015
Jul 14, 2023
Careconnect Convenient CareHawkinsville, GA, CCN 111029 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 9, 2022
Feb 1, 2016
Pediatric Urgent CareCordele, GA, CCN 111039 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 10, 2016
May 10, 2016
New Hope ClinicCordele, GA, CCN 111054 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 10, 2017
Jan 10, 2017
Careconnect Convenient CarePerry, GA, CCN 111055 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 9, 2017
Careconnect Family Practice and PediatricsAshburn, GA, CCN 111056 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 13, 2017
Careconnect Convenient CareTifton, GA, CCN 111080 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 6, 2017
Jun 9, 2017
Careconnect Convenient CareCuthbert, GA, CCN 111079 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 19, 2017
Jun 19, 2017
Careconnect PediatricsCordele, GA, CCN 111068 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 20, 2017
Jul 20, 2017
Careconnect Urgent CareGriffin, GA, CCN 111071 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control (100%)		 Jul 1, 2017
Jul 1, 2017
Careconnect Convenient CareFort Valley, GA, CCN 111082 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Other (100%)		 Jan 19, 2018
Jan 19, 2018
Jan 19, 2018
Pediatric Convenient CareTifton, GA, CCN 111088 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 2, 2018
May 2, 2018
Careconnect PediatricsMoultrie, GA, CCN 111094 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 26, 2018
Jul 26, 2018
Careconnect Family PracticeAlamo, GA, CCN 111102 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 21, 2018
Sep 21, 2018
Careconnect Convenient CareGriffin, GA, CCN 111099 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 19, 2018
Nov 19, 2018
Careconnect Convenient CareDawson, GA, CCN 851053 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 11, 2021
May 11, 2021
New Hope ClinicAmericus, GA, CCN 851164 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 23, 2022
Feb 23, 2022

Facilities with the same owner 26

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

View all 26

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651622400000",
    "number": "1447833926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5610",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310105610",
            "telephone_number": "229-273-8881",
            "fax_number": "229-273-8985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1114 GA HIGHWAY 96 STE D3-D5",
            "city": "KATHLEEN",
            "state": "GA",
            "postal_code": "310472111",
            "telephone_number": "478-910-1090",
            "fax_number": "478-910-1091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARECONNECT HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-03",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "EXECUTIVE SECRETARY",
        "authorized_official_telephone_number": "229-273-8881"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Convenient Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kathleen, GA

Sources for this page

Verify at the official NPI Registry.