NPIMap

Organization Active NPI

Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
National Provider Identifier
1780224352
Registry record updated Jan 13, 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
3219 College St
Savannah, GA 31404-5254
Phone
(912) 527-1000
NPI assigned
Jan 13, 2020
Organization subpart
Yes
Parent organization
CURTIS V COOPER PRIMARY HEALTHCARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2020

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

Authorized official

Name
Athelstane Seraphin
Title
Coi
Phone
(912) 527-1130

Specialties & licenses 1

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

Addresses

Primary practice location

3219 College St
Savannah, GA 31404-5254

Mailing address

106 E Broad St
Savannah, GA 31401-2917

Medicare participation

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

Enrollment records 2

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
O20201123003420 GA Part A Provider - Federally Qualified Health Center (FQHC) 4789667015 Practice locations: Savannah, GA

Federally qualified health center certification: CCN 111137

Legal name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 16, 2020
Last certification
Nov 16, 2020
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 13, 2020 in GA
Enrollment address
3219 College St
Savannah, GA 31404-5254

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Curtis V Cooper Primary Hea16 organizations share this tax ID, including this one
Part of
Curtis V Cooper Primary Hea

Other organizations with this tax ID 15

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

View all 15

Locations

3219 College St
Savannah, GA 31404
Phone (912) 358-3439

Ownership & related parties

All disclosed owners & managing parties 9

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 DirectorBoard Member Jan 1, 2020
Juliet Wade Individual Corporate DirectorBoard Member Jan 1, 2012
Larry Jackson Individual Corporate DirectorBoard Chair Jan 1, 2014
Earlene J Daniels Individual Corporate OfficerCfo Jan 1, 2018 100%
Operational/Managerial ControlCfo Jan 1, 2018 100%
Lester Johnson Individual Corporate DirectorBoard Vice Chair Jan 1, 2019
Roy Devonne Flood Individual Corporate DirectorBoard Member Jan 1, 2019
Mary Hill Individual Corporate DirectorBoard Member Jan 1, 2023
Ray Truitt Individual Corporate DirectorBoard Member Jan 1, 2020
Deborah Wright Individual Corporate DirectorBoard Treasurer Jan 1, 2019

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578873600000",
    "number": "1780224352",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3219 COLLEGE ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314045254",
            "telephone_number": "912-527-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CURTIS V. COOPER PRIMARY HEALTH CARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CURTIS V COOPER PRIMARY HEALTHCARE, INC",
        "enumeration_date": "2020-01-13",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A",
        "authorized_official_last_name": "SERAPHIN",
        "authorized_official_first_name": "ATHELSTANE",
        "authorized_official_title_or_position": "COI",
        "authorized_official_telephone_number": "912-527-1130"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.