NPIMap

Organization Active NPI

Saint Joseph's Mercy Care Services, Inc.

Doing business as Saint Joseph's Mercy Care - The Imperial

  • Federally Qualified Health Center (FQHC)
  • Atlanta, GA
National Provider Identifier
1689090896
Registry record updated Sep 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAINT JOSEPH'S MERCY CARE SERVICES, INC.
Doing business as
Saint Joseph's Mercy Care - The Imperial
Practice address
355 Peachtree St NE
Atlanta, GA 30308-3256
Phone
(404) 410-1420
NPI assigned
Mar 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2014

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

Authorized official

Name
Mr. E Thomas Andrews
Title
President
Phone
(678) 843-8502

Specialties & licenses 1

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

Addresses

Primary practice location

355 Peachtree St NE
Atlanta, GA 30308-3256

Mailing address

424 Decatur St SE
Atlanta, GA 30312-1848
Phone (678) 843-8600

Other identifiers 1

IdentifierTypeStateIssuer
003145199AMedicaidGA

Other names 1

  • Saint Joseph's Mercy Care - The Imperial Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050516000862 GA Part B Supplier - Clinic/Group Practice 9931191525 Receives reassigned benefits from 62 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atlanta, GA; Chamblee, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689090896. Details of each certification follow.

  • CCN 111007 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 111007

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SAINT JOSEPH'S MERCY CARE-THE IMPERIAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 11, 2014
Last certification
Nov 11, 2014
Ownership / control type
For profit – corporation
Facility address
355 Peachtree Street NE
Atlanta, GA 30308

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

NPI Registry JSON

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

{
    "created_epoch": "1394582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409788800000",
    "number": "1689090896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 DECATUR ST SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121848",
            "telephone_number": "678-843-8600",
            "fax_number": "678-843-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 PEACHTREE ST NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303083256",
            "telephone_number": "404-410-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT JOSEPH'S MERCY CARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-12",
        "last_updated": "2014-09-04",
        "status": "A",
        "authorized_official_last_name": "ANDREWS",
        "authorized_official_first_name": "E THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-843-8502",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "003145199A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saint Joseph's Mercy Care - The Imperial",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.