NPIMap

Organization Active NPI

Valley Healthcare System Inc

  • Federally Qualified Health Center (FQHC)
  • Columbus, GA
National Provider Identifier
1609814219
Registry record updated Jul 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VALLEY HEALTHCARE SYSTEM INC
Practice address
1600 Fort Benning Road
Columbus, GA 31903-2407
Phone
(706) 322-9599
Fax
(706) 322-9567
NPI assigned
Jun 4, 2006
Last updated
Jul 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2018

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

Authorized official

Name
Sarah E Lang
Title
Ceo
Phone
(706) 322-9599

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

1600 Fort Benning Road
Columbus, GA 31903-2407

Mailing address

1600 Fort Benning Road
Columbus, GA 31903-2407
Phone (706) 322-9599

Other identifiers 3

IdentifierTypeStateIssuer
000617196AMedicaidGA
202G702049OtherGAMEDICARE PTAN
630000022MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20030514000075 GA Part A Provider - Federally Qualified Health Center (FQHC) 8628988276 Practice locations: Columbus, GA
O20040528000880 GA Part B Supplier - Clinic/Group Practice 8628988276 Receives reassigned benefits from 34 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Columbus, GA; Fortson, GA; Talbotton, GA
O20130905000165 GA Part B Supplier - Mass Immunization (Roster Biller Only) 8628988276 Practice locations: Columbus, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609814219. Details of each certification follow.

Federally qualified health center certification: CCN 111828

Legal name
VALLEY HEALTHCARE SYSTEM INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 22, 1994
Last certification
Jun 22, 1994
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 27, 1992 in GA
Enrollment address
1600 Fort Benning Rd
Columbus, GA 31903-2834

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Ownership & related parties

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.

NameRoleSinceShare
Maxine Lee Individual Corporate Director Jul 1, 2003
Frank Myers Individual Corporate Director Jul 1, 2003
Sarah Lang Individual 5% Or Greater Direct Ownership InterestChief Executive Officer Feb 28, 1994 100%
Corporate OfficerChief Executive Officer Feb 28, 1994 100%
Rannie Lewis Individual Corporate Director Jul 1, 2003
Phillip Aldridge Individual Corporate Director Jul 1, 2003
Virginia Dickerson Individual Corporate Director Jul 1, 2003
James Crosse Individual Corporate Director Jul 1, 2003
Don Cook Individual Corporate Director Jul 1, 2003
Diana Montenegro Individual W-2 Managing Employee Jul 24, 2009
Elizabeth Dillard-Berryhill Individual Corporate Director Jul 1, 2003
Jennifer Melvin Individual W-2 Managing EmployeeCfo Jun 9, 2009
Mattie Wright Individual Corporate Director Jul 1, 2003
Brenda Carol Wilson Individual W-2 Managing Employee Jun 3, 2009

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Valley Healthcare System IncFortson, GA, CCN 111927 Federally qualified health center Operational/Managerial Control Jan 8, 2010

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 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530576000000",
    "number": "1609814219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 FORT BENNING ROAD",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319032407",
            "telephone_number": "706-322-9599",
            "fax_number": "706-322-9567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 FORT BENNING ROAD",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319032407",
            "telephone_number": "706-322-9599",
            "fax_number": "706-322-9567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY HEALTHCARE SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2018-07-03",
        "status": "A",
        "authorized_official_last_name": "LANG",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-322-9599"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000617196A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "202G702049",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630000022",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

Verify at the official NPI Registry.