Four Corners Primary Care Centers Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

FOUR CORNERS PRIMARY CARE CENTERS INC

Practice address

115 Towne Center Pkwy
Suite 113
Hoschton, GA 30548-2213

Phone

(770) 806-2928

NPI assigned

Mar 22, 2016

Last updated

Feb 28, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brian Willams, MD

Title

Ceo

Phone

(770) 806-2928

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548622285. Details of each certification follow.

• CCN 111059 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 111059

Legal name

FOUR CORNERS PRIMARY CARE CENTERS, INC.

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

May 19, 2016

Last certification

May 19, 2016

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

May 6, 2007 in GA

Enrollment address

115 Towne Center Pkwy
Ste 113
Hoschton, GA 30548-2222

Other NPIs with the same Medicare PAC ID 3

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

• Four Corners Primary Care Centers Inc

  dba Four Corners @ VPH

  • Federally Qualified Health Center (FQHC)
  • Norcross, GA
  • NPI 1265624548

  1951497494

  Same PAC ID
• Four Corners Primary Care Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lawrenceville, GA
  • NPI 1285325282

  1951497494

  Same PAC ID
• Four Corners Primary Care Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lawrenceville, GA
  • NPI 1356682959

  1951497494

  Same PAC ID

Tax ID family

Four Corners Primary Care Centers Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Four Corners Primary Care Centers, Inc.

  • Pharmacy
  • Norcross, GA
  • NPI 1235648817
  NPD tax ID
• Four Corners Primary Care Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lawrenceville, GA
  • NPI 1285325282
  NPD tax ID
• Four Corners Primary Care Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lawrenceville, GA
  • NPI 1356682959
  NPD tax ID

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.

Practitioners 1

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.

• Aziz A Pirani, MD

  • Family Medicine Physician
  • Lilburn, GA
  • NPI 1760622096
  NPD (past)

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551312000000",
    "number": "1548622285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 OAKBROOK PKWY",
            "address_2": "SUITE 130",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300932256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 TOWNE CENTER PKWY",
            "address_2": "SUITE 113",
            "city": "HOSCHTON",
            "state": "GA",
            "postal_code": "305482213",
            "telephone_number": "770-806-2928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS PRIMARY CARE CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2019-02-28",
        "status": "A",
        "authorized_official_last_name": "WILLAMS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-806-2928",
        "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": []
}

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• Federally Qualified Health Center (FQHC) in Hoschton, GA
• Providers in Hoschton, GA by specialty
• Federally Qualified Health Center (FQHC) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.