NPIMap

Organization Active NPI

Georgia Highlands Medical Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Canton, GA
National Provider Identifier
1811501455
Registry record updated May 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GEORGIA HIGHLANDS MEDICAL SERVICES, INC
Practice address
210 Oakside LN
Canton, GA 30114-6417
Phone
(678) 807-1050
Fax
(770) 720-7384
NPI assigned
Sep 1, 2020
Organization subpart
Yes
Parent organization
GEORGIA HIGHLANDS MEDICAL SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 9, 2022

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

Authorized official

Name
Todd Shiflett
Title
Ceo
Phone
(770) 887-1668

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

210 Oakside LN
Canton, GA 30114-6417

Mailing address

PO Box 307
Cumming, GA 30028-0307
Phone (678) 807-1050

Other identifiers 3

IdentifierTypeStateIssuer
003245090AMedicaidGA
GRP1700OtherGAGROUP MEDICARE
300022400AMedicaidGA

Other names 1

  • GHMS Canton Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040302001307 GA Part B Supplier - Clinic/Group Practice 5890682017 Receives reassigned benefits from 26 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Canton, GA; Dawsonville, GA; Cumming, GA; Cartersville, GA; Buford, GA
O20200923000157 GA Part A Provider - Federally Qualified Health Center (FQHC) 5890682017 Practice locations: Canton, GA

Federally qualified health center certification: CCN 111135

Legal name
GEORGIA HIGHLANDS MEDICAL SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 16, 2020
Last certification
Sep 16, 2020
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 2020 in GA
Enrollment address
210 Oakside LN
Canton, GA 30114-6417

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Georgia Highlands Medic8 organizations share this tax ID, including this one
Part of
Georgia Highlands Medic

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Elba Montalvo-Torres Individual Corporate DirectorBoard Member May 18, 2010
Gary Riggs Individual Corporate DirectorBoard Treasurer Jun 21, 2016
Todd Shifflet Individual Corporate OfficerCeo Apr 13, 2015 100%
Corporate DirectorCeo Apr 13, 2015 100%
Cheryl Cagle Individual Corporate DirectorBoard Member Nov 1, 2016
Jesann Hendrix Individual Corporate DirectorBoard Member May 18, 2010
Donald Fortenberry Individual Corporate DirectorBoard Member Nov 1, 2016
Stephen Brown Individual Corporate OfficerCfo Apr 19, 2017 99%
Operational/Managerial ControlCfo Apr 19, 2017 99%
Elizabeth Garcia Individual Corporate DirectorBoard Member Nov 1, 2016
Ruth Baumann Individual Corporate DirectorBoard Secretary May 18, 2020
David Keith Pruitt Individual Corporate DirectorBoard President Nov 1, 2014
Gina Santos Individual Corporate DirectorBoard Member May 18, 2010

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Georgia Highlands Medical Services, Inc.Cumming, GA, CCN 111195 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2022

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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1598918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652054400000",
    "number": "1811501455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 307",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300280307",
            "telephone_number": "678-807-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 OAKSIDE LN",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301146417",
            "telephone_number": "678-807-1050",
            "fax_number": "770-720-7384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA HIGHLANDS MEDICAL SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA HIGHLANDS MEDICAL SERVICES, INC",
        "enumeration_date": "2020-09-01",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A",
        "authorized_official_last_name": "SHIFLETT",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-887-1668"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003245090A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE",
            "identifier": "GRP1700",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300022400A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GHMS Canton Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GHMS Canton Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, GA

Sources for this page

Verify at the official NPI Registry.