NPIMap

Organization Active NPI

Rural Health Care, Incorporated

  • Federally Qualified Health Center (FQHC)
  • St Augustine, FL
National Provider Identifier
1629324751
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL HEALTH CARE, INCORPORATED
Practice address
105 Whitehall Dr
Suites 109-114
St Augustine, FL 32086-5269
Phone
(904) 829-2782
Fax
(904) 829-2494
NPI assigned
Jul 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Authorized official

Name
Laura M. Spencer
Title
Chief Executive Officer
Phone
(386) 328-0108

Specialties & licenses 1

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

Addresses

Primary practice location

105 Whitehall Dr
Suites 109-114
St Augustine, FL 32086-5269

Mailing address

1302 River St
Palatka, FL 32177-5042
Phone (386) 328-0108

Other identifiers 1

IdentifierTypeStateIssuer
029543414MedicaidFL

Other names 2

  • Aza Health Doing business as
  • Azalea Health Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031219000375 FL Part B Supplier - Clinic/Group Practice 7214849520 Receives reassigned benefits from 82 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Keystone Heights, FL; Welaka, FL; St Augustine, FL; Palm Coast, FL; Palatka, FL; Interlachen, FL; Hawthorne, FL; Hasting, FL…
O20121012000484 FL Part A Provider - Federally Qualified Health Center (FQHC) 7214849520 Practice locations: St Augustine, FL

Federally qualified health center certification: CCN 101097

Legal name
RURAL HEALTH CARE INCORPORATED
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1977 in FL
Enrollment address
105 Whitehall Dr
Ste 109-114
St Augustine, FL 32086-5269

Other NPIs with the same Medicare PAC ID 10

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.

National Provider Directory

National Provider Directory
Tax ID family
Rural Health Care Inc25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Locations

105 Whitehall Dr
Ste 109
St Augustine, FL 32086
Phone (904) 829-2782

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Kathy L Dean Individual Corporate DirectorBoard Member Aug 6, 2012
Sabrina Thomas Individual Corporate DirectorBoard Member Aug 6, 2012
Elizabeth C Fisher Individual Corporate DirectorBoard Member Aug 6, 2012
Laura Spencer Individual Corporate OfficerPresident/Ceo Aug 6, 2012
W-2 Managing EmployeePresident/Ceo Aug 6, 2012
Joseph Giacomo Individual Corporate OfficerChief Financial Officer May 20, 2019
W-2 Managing EmployeeChief Financial Officer May 20, 2019
Donavan Bardier Individual Corporate DirectorBoard Member Jan 1, 2024
Lucia Valdivia-Sanchez Individual Corporate DirectorBoard Member Jan 28, 2019
Moses a Floyd Individual Corporate DirectorBoard Member Jan 22, 2013
Constance Schneider Individual Corporate DirectorBoard Member Jan 1, 2020
Lashonda Simmons-Watson Individual Corporate DirectorBoard Member Aug 6, 2012

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1343260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1629324751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 RIVER ST",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321775042",
            "telephone_number": "386-328-0108",
            "fax_number": "386-325-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 WHITEHALL DR",
            "address_2": "SUITES 109-114",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865269",
            "telephone_number": "904-829-2782",
            "fax_number": "904-829-2494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH CARE, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-26",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "386-328-0108"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029543414",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aza Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Azalea Health",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.