NPIMap

Organization Active NPI

Primary Health Care Center of Dade, Inc.

  • Federally Qualified Health Center (FQHC)
  • Tunnel Hill, GA
National Provider Identifier
1699016527
Registry record updated Mar 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY HEALTH CARE CENTER OF DADE, INC.
Practice address
134 Rhea McClanahan Dr
Tunnel Hill, GA 30755-7328
Phone
(706) 866-5520
Fax
(706) 866-5512
NPI assigned
Mar 1, 2013
Last updated
Mar 1, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2013

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

Authorized official

Name
Amy L Buffington
Title
Credentialing Coordinator
Phone
(706) 866-5520

Specialties & licenses 1

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

Addresses

Primary practice location

134 Rhea McClanahan Dr
Tunnel Hill, GA 30755-7328

Mailing address

13570 N Main St
Trenton, GA 30752-2012
Phone (706) 657-7575

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060607000231 GA Part B Supplier - Clinic/Group Practice 0547272650 Receives reassigned benefits from 10 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Summerville, GA; Tunnel Hill, GA; Trenton, GA; Rossville, GA; Ringgold, GA; La Fayette, GA; Fort Oglethorpe, GA
O20130509000391 GA Part A Provider - Federally Qualified Health Center (FQHC) 0547272650 Practice locations: Tunnel Hill, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699016527. Details of each certification follow.

Federally qualified health center certification: CCN 111960

Legal name
PRIMARY HEALTH CARE CENTER OF DADE, INC
Doing business as
TIGER CREEK ELEMENTARY SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 9, 2013
Last certification
May 9, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 2, 1980 in GA
Enrollment address
134 Rhea McClanahan Dr
Tunnel Hill, GA 30755-7328

Other NPIs with the same Medicare PAC ID 9

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.

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
11D2063663Tiger Creek Elementary School134 Rhea McClanahan Drive, Tunnel Hill, GA 30755Certificate of waiverAug 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Primary Health Care Center of Dade Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

134 Rhea McClanahan Dr
Ph
Tunnel Hill, GA 30755

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
Maritza McKinney Individual OtherBoard Member Apr 15, 2026
Kay Henderson Individual OtherBoard Member Jul 12, 2024
Primary Health Care Center of Dade, Inc Organization, Tunnel Hill, GA Non-profit Other Mar 1, 2013
Susan Wells Individual OtherBoard Member Jul 12, 2024
Norman Menard Individual OtherBoard Member Apr 15, 2026
Andrew Plisko Individual OtherBoard Member Jul 12, 2024
Dale Thomas Dreiling Individual OtherBoard Member Apr 15, 2026
Ruben Olm Individual OtherBoard Member Apr 15, 2026
Richard Christman Individual W-2 Managing EmployeeAd; Apr 15, 2026 100%
Davis Brown Individual OtherBoard Member Apr 15, 2026
Michael Caldwell Individual OtherBoard Member Apr 15, 2026
Amy Buffington Individual Corporate DirectorCredentialing Director Jun 11, 2010 100%
W-2 Managing EmployeeCredentialing Director Jun 1, 1999
Talisyn Ridley Individual OtherBoard Member Jul 30, 2021

Owners & managing parties with NPI records 9

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

Practitioners & affiliated clinicians

Practitioners 6

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": "1362096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362096000000",
    "number": "1699016527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13570 N MAIN ST",
            "city": "TRENTON",
            "state": "GA",
            "postal_code": "307522012",
            "telephone_number": "706-657-7575",
            "fax_number": "706-866-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 RHEA MCCLANAHAN DR",
            "city": "TUNNEL HILL",
            "state": "GA",
            "postal_code": "307557328",
            "telephone_number": "706-866-5520",
            "fax_number": "706-866-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY HEALTH CARE CENTER OF DADE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-01",
        "last_updated": "2013-03-01",
        "status": "A",
        "authorized_official_last_name": "BUFFINGTON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "706-866-5520"
    },
    "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 Tunnel Hill, GA

Sources for this page

Verify at the official NPI Registry.