NPIMap

Organization Active NPI

Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lithonia, GA
National Provider Identifier
1609374842
Registry record updated Jun 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MEDCURA HEALTH, INC.
Practice address
5910 Hillandale Dr Ste 102
Lithonia, GA 30058-1877
Phone
(404) 400-9829
NPI assigned
Jan 23, 2018
Last updated
Jun 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2021

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

Authorized official

Name
Jeff Taylor
Title
Ceo
Phone
(404) 298-3250

Specialties & licenses 1

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

Addresses

Primary practice location

5910 Hillandale Dr Ste 102
Lithonia, GA 30058-1877

Mailing address

5582 Memorial Dr
Stone Mountain, GA 30083-3215

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120509000245 GA Part B Supplier - Clinic/Group Practice 2961443643 Receives reassigned benefits from 112 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stone MTN, GA; Stone Mountain, GA; Smyrna, GA; Lithonia, GA; Conyers, GA; Doraville, GA; Decatur, GA; Atlanta, GA…
O20180723000392 GA Part A Provider - Federally Qualified Health Center (FQHC) 2961443643 Practice locations: Lithonia, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609374842. Details of each certification follow.

Federally qualified health center certification: CCN 111092

Legal name
MEDCURA HEALTH, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 23, 2018
Last certification
Jul 23, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1981 in GA
Enrollment address
5910 Hillandale Dr
Ste 102
Lithonia, GA 30058-1877

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 13

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

View all 13

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
11D2142131Medcura Health- Hillandale5910 Hillandale Drive, Suite 102, Lithonia, GA 30058Provider-performed microscopyJan 3, 2028

National Provider Directory

National Provider Directory
Tax ID family
Medcura Health Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Jeffrey Taylor Individual Corporate OfficerCeo Feb 9, 2018 100%
Operational/Managerial ControlCeo Feb 9, 2018 100%

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Medcura Health, IncStone Mountain, GA, CCN 111962 Federally qualified health center Operational/Managerial Control (100%)
Other (100%)		 May 9, 2005
May 9, 2005

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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": "1516665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622851200000",
    "number": "1609374842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5582 MEMORIAL DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5910 HILLANDALE DR STE 102",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300581877",
            "telephone_number": "404-400-9829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDCURA HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-23",
        "last_updated": "2021-06-05",
        "certification_date": "2021-06-05",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-298-3250"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lithonia, GA

Sources for this page

Verify at the official NPI Registry.