NPIMap

Organization Active NPI

First Choice Primary Care, Inc

Doing business as FCPC Bruce Elementary SBHC

  • Federally Qualified Health Center (FQHC)
  • Macon, GA
National Provider Identifier
1780480830
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FIRST CHOICE PRIMARY CARE, INC
Doing business as
FCPC Bruce Elementary SBHC
Practice address
3660 Houston Ave
Macon, GA 31206-2414
Phone
(478) 787-4266
Fax
(478) 787-7199
NPI assigned
Feb 20, 2025
Last updated
Jul 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

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

Authorized official

Name
Katherine McLeod
Title
Ceo
Phone
(478) 254-7204

Specialties & licenses 1

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

Addresses

Primary practice location

3660 Houston Ave
Macon, GA 31206-2414

Mailing address

PO Box 4363
Macon, GA 31208-4363
Phone (478) 787-4266

Other names 1

  • FCPC Bruce Elementary SBHC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250613002937 GA Part A Provider - Federally Qualified Health Center (FQHC) 6103907316 Practice locations: Macon, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780480830. Details of each certification follow.

Federally qualified health center certification: CCN C21039

Legal name
FIRST CHOICE PRIMARY CARE, INC.
Doing business as
FCPC BRUCE ELEMENTARY SBHC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 27, 2025
Last certification
May 27, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
3660 Houston Ave
Macon, GA 31206-2414

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
First Choice Primary Care Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

3061 Houston Ave
Macon, GA 31206
Phone 47878742662129

400 Poplar St
Macon, GA 31201
Phone (478) 309-1744

770 Walnut St
Macon, GA 31201
Phone (478) 755-1110

855 Anthony Rd
Macon, GA 31204

233 N Houston Rd
Ste 141
Warner Robins, GA 31093
Phone (478) 225-6999

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Timothy L Graves Individual W-2 Managing EmployeeMD; Nov 1, 2007
Mable Wheeler Individual Corporate DirectorBoard Member Jul 1, 2007
Camille Hope Individual Corporate DirectorBoard Member Jul 1, 2007
Thomas Duval Individual Corporate DirectorBoard Member Jun 21, 2008
Elbert McQueen Individual Corporate DirectorBoard Treasurer Apr 23, 2015
Macheita Adams Individual Corporate DirectorBoard Member Jul 14, 2022
David C Parish Individual Corporate DirectorBoard Secretary Jul 1, 2007
Marvin Riggins Individual Corporate DirectorBoard President Sep 4, 2011
Jonathan Alderman Individual Corporate DirectorBoard Member Jul 1, 2007
Katherine McLeod Individual W-2 Managing EmployeeAd; Nov 1, 2007
Fundisani Mangena Individual W-2 Managing EmployeeChief Operating Officer Aug 14, 2023
Linda Holland Individual Corporate DirectorBoard Vice President Jun 21, 2008
Steven Corkery Individual Corporate DirectorBoard Member Sep 24, 2011
First Choice Primary Care, Inc. Organization, Macon, GA Non-profit Operational/Managerial Control May 1, 2025 100%
Roz McMillan Individual Corporate DirectorBoard Member Jul 1, 2007
Claudette Slade Individual W-2 Managing EmployeeChief Financial Officer Jun 28, 2016
Antonio Lewis-Ross Individual Corporate DirectorBoard Member Sep 2, 2021
Bernice Eboh Individual Corporate DirectorBoard Member Dec 2, 2021

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
First Choice Primary Care, Inc.Macon, GA, CCN 111069 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1740009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751846400000",
    "number": "1780480830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4363",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312084363",
            "telephone_number": "478-787-4266",
            "fax_number": "478-787-7199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3660 HOUSTON AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312062414",
            "telephone_number": "478-787-4266",
            "fax_number": "478-787-7199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST CHOICE PRIMARY CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-20",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A",
        "authorized_official_last_name": "MCLEOD",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "478-254-7204"
    },
    "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": "FCPC Bruce Elementary SBHC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FCPC Bruce Elementary SBHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.