NPIMap

Organization Active NPI

Saint Joseph's Mercy Care Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Chamblee, GA
National Provider Identifier
1568818151
Registry record updated Oct 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAINT JOSEPH'S MERCY CARE SERVICES, INC.
Practice address
5134 Peachtree Rd
Chamblee, GA 30341-2724
Phone
(678) 843-8700
Fax
(404) 633-0502
NPI assigned
May 12, 2016
Last updated
Oct 17, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2019

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

Authorized official

Name
Earl Thomas Andrews
Title
President
Phone
(678) 843-8502

Specialties & licenses 1

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

Addresses

Primary practice location

5134 Peachtree Rd
Chamblee, GA 30341-2724

Mailing address

424 Decatur St SE
Atlanta, GA 30312-1848
Phone (678) 843-8600

Other identifiers 2

IdentifierTypeStateIssuer
0031868004AMedicaidGA
11-1053OtherGAMEDICARE

Other names 1

  • Saint Joseph's Mercy Care Chamblee Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050516000862 GA Part B Supplier - Clinic/Group Practice 9931191525 Receives reassigned benefits from 62 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atlanta, GA; Chamblee, GA
O20170222000731 GA Part A Provider - Federally Qualified Health Center (FQHC) 9931191525 Practice locations: Chamblee, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568818151. Details of each certification follow.

Federally qualified health center certification: CCN 111053

Legal name
SAINT JOSEPH'S MERCY CARE SERVICES INC
Doing business as
MERCY AT CHAMBLEE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 22, 2017
Last certification
Feb 22, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 25, 2005 in GA
Enrollment address
5134 Peachtree Rd
Chamblee, GA 30341-2724

Other NPIs with the same Medicare PAC ID 5

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
11D2126199Mercy Care Chamblee5134 Peachtree Road, Chamblee, GA 30341Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Central Health Center13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Erica Stokes Individual Corporate OfficerCfo Jan 25, 2005
W-2 Managing EmployeeCfo Jan 1, 2012
Steven Siler Individual Corporate OfficerPresident Aug 1, 2016
Corporate DirectorBoard Member Aug 1, 2016
W-2 Managing EmployeePresident Aug 1, 2016
Catholic Health East Controls Saint Josephs Health System Inc Organization, Atlanta, GA Non-profit 5% Or Greater Indirect Ownership Interest Apr 1, 2001 100%
Kathryn Lawler Individual Corporate OfficerCeo & Board Member May 1, 2022
Corporate DirectorCeo & Board Member May 1, 2022
W-2 Managing EmployeeCeo & Board Member May 1, 2022
Jane Gerety Individual Corporate OfficerSecretary Jan 1, 2020
Alicia Williams Individual OtherRevenue Cycle Manager May 14, 2017
Trinity Health Corporation Organization, Livonia, MI Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2017 100%

Facilities with the same owner 157

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

View all 157

Practitioners & affiliated clinicians

Practitioners 4

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": "1463011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571270400000",
    "number": "1568818151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 DECATUR ST SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121848",
            "telephone_number": "678-843-8600",
            "fax_number": "678-843-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5134 PEACHTREE RD",
            "city": "CHAMBLEE",
            "state": "GA",
            "postal_code": "303412724",
            "telephone_number": "678-843-8700",
            "fax_number": "404-633-0502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT JOSEPH'S MERCY CARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-12",
        "last_updated": "2019-10-17",
        "status": "A",
        "authorized_official_last_name": "ANDREWS",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-843-8502"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0031868004A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "11-1053",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saint Joseph's Mercy Care Chamblee",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Saint Joseph's Mercy Care Chamblee",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chamblee, GA

Sources for this page

Verify at the official NPI Registry.