NPIMap

Organization Active NPI

TMC Buchanan Family Healthcare Center

Doing business as Buchanan Medical Clinic

  • Rural Health Clinic/Center
  • Buchanan, GA
National Provider Identifier
1508801416
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TMC BUCHANAN FAMILY HEALTHCARE CENTER
Doing business as
Buchanan Medical Clinic
Practice address
2908 Business 27
Buchanan, GA 30113-4857
Phone
(770) 646-8281
Fax
(770) 646-3579
NPI assigned
Jun 17, 2006
Last updated
Feb 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Authorized official

Name
Clint Hoffman
Title
Sr VP
Phone
(770) 812-8845

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 024466 GA
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

2908 Business 27
Buchanan, GA 30113-4857

Mailing address

100 Greenway Blvd FL 2
Carrollton, GA 30117-4338
Phone (770) 838-8710

Other names 1

  • Buchanan Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040427000255 GA Part B Supplier - Clinic/Group Practice 9032106604 Receives reassigned benefits from 8 practitioners
Practice locations: Buchanan, GA
O20140808001950 GA Part A Provider - Rural Health Clinic 9032106604 Practice locations: Buchanan, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508801416. Details of each certification follow.

Rural health clinic certification: CCN 118549

Legal name
TMC BUCHANAN FAMILY HEALTHCARE CENTER
Doing business as
BUCHANAN MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 22, 2014
Last certification
Aug 24, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 17, 1999 in GA
Enrollment address
2908 Business 27
Buchanan, GA 30113-4857
Related CCNs
111320

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

109 Allen Memorial Dr
#A
Bremen, GA 30110
Phone (770) 824-2100

706 Dixie St
Ste 220
Carrollton, GA 30117
Phone (770) 812-8825

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Carol Crews Individual Corporate OfficerChief Financial Officer Jun 18, 2012
W-2 Managing EmployeeCfo Aug 1, 2013
Tanner Medical Center Inc Organization, Carrollton, GA Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2013 100%

Owners & managing parties with NPI records 4

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

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1508801416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GREENWAY BLVD FL 2",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174338",
            "telephone_number": "770-838-8710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2908 BUSINESS 27",
            "city": "BUCHANAN",
            "state": "GA",
            "postal_code": "301134857",
            "telephone_number": "770-646-8281",
            "fax_number": "770-646-3579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TMC BUCHANAN FAMILY HEALTHCARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "CLINT",
        "authorized_official_title_or_position": "SR VP",
        "authorized_official_telephone_number": "770-812-8845"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "024466",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Buchanan Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Buchanan Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buchanan, GA

Sources for this page

Verify at the official NPI Registry.