NPIMap

Organization Active NPI

Rural Health Care Incorporated

Doing business as Aza Health

  • Federally Qualified Health Center (FQHC)
  • Palm Coast, FL
National Provider Identifier
1780064808
Registry record updated Jun 29, 2021
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
Doing business as
Aza Health
Practice address
460 Palm Coast Pkwy SW
Suite 5
Palm Coast, FL 32137-4785
Phone
(386) 246-3954
Fax
(386) 246-3960
NPI assigned
Jun 3, 2015
Last updated
Jun 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Authorized official

Name
Laura M. Spencer
Title
President/Ceo
Phone
(386) 328-0108

Specialties & licenses 1

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

Addresses

Primary practice location

460 Palm Coast Pkwy SW
Suite 5
Palm Coast, FL 32137-4785

Mailing address

1302 River St
Palatka, FL 32177-5042
Phone (386) 326-7342

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…
O20150908000042 FL Part A Provider - Federally Qualified Health Center (FQHC) 7214849520 Practice locations: Palm Coast, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780064808. Details of each certification follow.

Federally qualified health center certification: CCN 681025

Legal name
RURAL HEALTH CARE INCORPORATED
Doing business as
AZA HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 8, 2015
Last certification
Sep 8, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1977 in FL
Enrollment address
460 Palm Coast Pkwy SW
Ste 5
Palm Coast, FL 32137-4786

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
Family Medical Ctr25 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

460 Palm Coast Pkwy SW
Ste 5
Palm Coast, FL 32137
Phone (386) 246-3954

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 Sep 29, 2010
Sabrina Thomas Individual Corporate DirectorBoard Member Jun 28, 2000
Elizabeth C Fisher Individual Corporate DirectorBoard Member Sep 29, 2010
Laura Spencer Individual Corporate OfficerChief Executive Officer Mar 1, 2010
W-2 Managing EmployeeChief Executive Officer Mar 1, 2010
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 Jan 25, 2006

Practitioners & affiliated clinicians

Practitioners 1

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": "1433289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1780064808",
    "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": "386-326-7342",
            "fax_number": "386-325-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 PALM COAST PKWY SW",
            "address_2": "SUITE 5",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321374785",
            "telephone_number": "386-246-3954",
            "fax_number": "386-246-3960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH CARE INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-03",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "386-328-0108"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Palm Coast, FL

Sources for this page

Verify at the official NPI Registry.