NPIMap

Organization Active NPI

Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
National Provider Identifier
1598373391
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC
Practice address
1501 Abercorn St
Savannah, GA 31401-7315
Phone
(912) 527-1100
NPI assigned
Jul 17, 2020
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CURTIS V. COOPER PRIMARY HEALTH CARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Athelstane Seraphin, CFO
Title
Cfo
Phone
(912) 527-1130

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1501 Abercorn St
Savannah, GA 31401-7315

Mailing address

106 E Broad St
Savannah, GA 31401-2917
Phone (912) 527-1100

Other names 1

  • CVC Jackson Dental Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Savannah Direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040609000352 GA Part B Supplier - Clinic/Group Practice 4789667015 Receives reassigned benefits from 77 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Savannah, GA; Prembroke, GA
O20200915000222 GA Part A Provider - Federally Qualified Health Center (FQHC) 4789667015 Practice locations: Savannah, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598373391. Details of each certification follow.

Federally qualified health center certification: CCN 111131

Legal name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Doing business as
CVC JACKSON DENTAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 15, 2020
Last certification
Sep 15, 2020
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1981 in GA
Enrollment address
1501 Abercorn St
Savannah, GA 31401-7315

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Westside Urban Health D20 organizations share this tax ID, including this one
Part of
Westside Urban Health D

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Paul Mosley Individual Corporate DirectorBoard Member Jan 1, 2020
Juliet Wade Individual Corporate DirectorBoard Member Jan 1, 2012
Larry Jackson Individual Corporate DirectorBoard Chair Jan 1, 2023
Earlene J Daniels Individual Corporate OfficerCfo Jan 1, 2018 100%
Operational/Managerial ControlCfo Jan 1, 2020 100%
Lester Johnson Individual Corporate DirectorBoard Vice Chair Jan 1, 2019
Roy Devonne Flood Individual Corporate DirectorBoard Member Jan 1, 2019
Mary Hill Individual Corporate DirectorBoard Member Jan 1, 2023
Ray Truitt Individual Corporate DirectorBoard Member Jan 1, 2020
Deborah Wright Individual Corporate DirectorBoard Treasurer Jan 1, 2019

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1594944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1598373391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 E BROAD ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314012917",
            "telephone_number": "912-527-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 ABERCORN ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314017315",
            "telephone_number": "912-527-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CURTIS V. COOPER PRIMARY HEALTH CARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CURTIS V. COOPER PRIMARY HEALTH CARE, INC",
        "enumeration_date": "2020-07-17",
        "last_updated": "2023-11-27",
        "certification_date": "2020-07-20",
        "status": "A",
        "authorized_official_last_name": "SERAPHIN",
        "authorized_official_first_name": "ATHELSTANE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "912-527-1130",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "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": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Savannah",
            "affiliation": "Y",
            "endpointDescription": "www.cvcphc.net",
            "use": "DIRECT",
            "useDescription": "Direct",
            "useOtherDescription": "Columbus",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1501 Abercorn St",
            "city": "Savannah",
            "state": "GA",
            "country_code": "US",
            "postal_code": "314017315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "CVC Jackson Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.