NPIMap

Organization Active NPI

Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Decatur, GA
National Provider Identifier
1790821023
Registry record updated Jun 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MEDCURA HEALTH, INC.
Practice address
1760 Candler Rd
Decatur, GA 30032-3254
Phone
(404) 286-2215
Fax
(404) 298-7658
NPI assigned
Jan 30, 2007
Last updated
Jun 5, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
OAKHURST MEDICAL CENTERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 5, 2021

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

Authorized official

Name
Mr. Jeffery Q Taylor
Title
Ceo
Phone
(404) 298-8998

Specialties & licenses 1

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

Addresses

Primary practice location

1760 Candler Rd
Decatur, GA 30032-3254

Mailing address

770 Village Square Dr
Stone Mountain, GA 30083-3380
Phone (404) 298-8998

Other identifiers 1

IdentifierTypeStateIssuer
000446388DMedicaidGA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101117001633 GA Part A Provider - Federally Qualified Health Center (FQHC) 2961443643 Practice locations: Decatur, GA
O20120509000245 GA Part B Supplier - Clinic/Group Practice 2961443643 Receives reassigned benefits from 112 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stone MTN, GA; Stone Mountain, GA; Smyrna, GA; Lithonia, GA; Conyers, GA; Doraville, GA; Decatur, GA; Atlanta, GA…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790821023. Details of each certification follow.

Federally qualified health center certification: CCN 111892

Legal name
MEDCURA HEALTH, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 31, 2005
Last certification
Oct 31, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1981 in GA
Enrollment address
1760 Candler Rd
Decatur, GA 30032-3254

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Medcura Health Inc15 organizations share this tax ID, including this one
Part of
Medcura Health Inc

Other organizations with this tax ID 14

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

View all 14

Locations

1760 Candler Rd
Decatur, GA 30032
Phone (404) 286-2215

5910 Hillandale Dr
Ste 102
Lithonia, GA 30058
Phone (770) 981-9011

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
Samuel Donwell Individual Corporate Director Sep 22, 2010
D'Nyce Williams Individual Corporate Director Sep 22, 2010
Brian O Williams Individual Corporate Director Sep 22, 2010
Jeffrey Taylor Individual Corporate OfficerCeo Dec 24, 2004
W-2 Managing EmployeeCeo Dec 24, 2004
Hussien Dido Individual Corporate DirectorBoard Member Nov 1, 2012
Kenneth Wilson Individual Corporate DirectorBoard Member Mar 27, 2007
Raulnina Uzzle Individual Corporate OfficerCmo Sep 1, 2000
Corporate Director Sep 22, 2010
Neb Solomon Individual Corporate DirectorBoard Member Mar 1, 2009
Adria Kitchens Individual Corporate Director Sep 22, 2010

Owners & managing parties with NPI records 2

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
Medcura Health, IncStone Mountain, GA, CCN 111962 Federally qualified health center Operational/Managerial Control (100%)
Other (100%)		 May 9, 2005
May 9, 2005

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622851200000",
    "number": "1790821023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 VILLAGE SQUARE DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833380",
            "telephone_number": "404-298-8998",
            "fax_number": "404-298-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 CANDLER RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300323254",
            "telephone_number": "404-286-2215",
            "fax_number": "404-298-7658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDCURA HEALTH, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OAKHURST MEDICAL CENTERS, INC.",
        "enumeration_date": "2007-01-30",
        "last_updated": "2021-06-05",
        "certification_date": "2021-06-05",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-298-8998",
        "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": "000446388D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

Verify at the official NPI Registry.