NPIMap

Organization Active NPI

Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
National Provider Identifier
1659668010
Registry record updated Jan 27, 2020
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
349 W Bryan St
Savannah, GA 31401-2356
Phone
(912) 527-1000
NPI assigned
Jul 6, 2011
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Earlene Joiner Daniels
Title
Chief Administrative Officer
Phone
(912) 527-1088

Owners & managing parties with NPI records 1

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

Other NPIs on the same Medicare enrollment 9

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

Other NPIs with the same Medicare PAC ID 12

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

Corporate family (same tax ID) 15

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

View all 15

Practitioners 81

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

View all 81

Medicare participation

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

Federally qualified health center certification: CCN 111833

Medicare enrollment files
Legal name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 1, 1995
Last certification
Aug 1, 1995
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1981 in GA
Enrollment address
349 W Bryan St
Savannah, GA 31401-2356

All disclosed owners & managing parties 10

Medicare enrollment files

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 Director Jan 1, 2019
Juliet Wade Individual Corporate Director Jan 1, 2012
Larry Jackson Individual Corporate Director Jan 1, 2021
Albert Grandy Individual Corporate OfficerCeo Jan 1, 2014
W-2 Managing EmployeeCeo Jul 16, 2014
Earlene J Daniels Individual Corporate OfficerCfo Jan 1, 2014
Tomas Figueroa Individual Corporate Director Jan 1, 2017
Helen Stone Individual Corporate Director Jan 1, 2014
Reginald Franklin Individual Corporate Director Jan 1, 2020
Roy Devonne Flood Individual Corporate Director Jan 1, 2017
Mary Hill Individual Corporate Director Jan 1, 2014

Medicare enrollment records 2

Medicare enrollment files
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
O20090923000745 GA Part a Provider - Federally Qualified Health Center (FQHC) 4789667015 1 other NPI on this enrollment
Practice locations: Savannah, GA

National Provider Directory

National Provider Directory
Tax ID family
Curtis V Cooper Primary Hea (16 organizations share this tax ID)

Locations

349 W Bryan St
Savannah, GA 31401
Phone (912) 527-1005

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

349 W Bryan St
Savannah, GA 31401-2356

Mailing address

106 E Broad St
Savannah, GA 31401-2917
Phone (912) 527-1000

Other names 1

NPPES NPI Registry
  • Westside Urban Health Center Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 27, 2020.

{
    "created_epoch": "1309910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1659668010",
    "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": "912-527-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "349 W BRYAN ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314012356",
            "telephone_number": "912-527-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CURTIS V. COOPER PRIMARY HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-06",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "EARLENE",
        "authorized_official_middle_name": "JOINER",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "912-527-1088"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westside Urban Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Westside Urban Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.