NPIMap

Organization Active NPI

Saint Joseph's Mercy Care Services, Inc.

Doing business as Saint Joseph's Mercy Care - GateWay

  • Federally Qualified Health Center (FQHC)
  • Atlanta, GA
National Provider Identifier
1821239708
Registry record updated Mar 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAINT JOSEPH'S MERCY CARE SERVICES, INC.
Doing business as
Saint Joseph's Mercy Care - GateWay
Practice address
275 Pryor St SW
Atlanta, GA 30303-3638
Phone
(678) 843-8840
NPI assigned
Mar 23, 2009
Last updated
Mar 24, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2009

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

Authorized official

Name
Mr. Thomas E. Andrews
Title
President
Phone
(678) 843-8503

Specialties & licenses 1

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

Addresses

Primary practice location

275 Pryor St SW
Atlanta, GA 30303-3638

Mailing address

424 Decatur St SE
Atlanta, GA 30312-1848
Phone (678) 843-8600

Other names 1

  • Saint Joseph's Mercy Care - GateWay Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050516000862 GA Part B Supplier - Clinic/Group Practice 9931191525 Receives reassigned benefits from 62 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atlanta, GA; Chamblee, GA
O20141111001374 GA Part A Provider - Federally Qualified Health Center (FQHC) 9931191525 Practice locations: Atlanta, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821239708. Details of each certification follow.

Federally qualified health center certification: CCN 111987

Legal name
SAINT JOSEPH'S MERCY CARE SERVICES INC
Doing business as
SAINT JOSEPH'S MERCY CARE- GATEWAY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 11, 2014
Last certification
Nov 11, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 25, 2005 in GA
Enrollment address
275 Pryor Street SW
Atlanta, GA 30303-3638

Other NPIs with the same Medicare PAC ID 5

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
Central Health Center13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

275 Pryor St SW
Atlanta, GA 30303
Phone (678) 843-8840

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Erica Stokes Individual 5% Or Greater Indirect Ownership Interest Nov 1, 2012
Corporate OfficerVP of Finance Nov 1, 2012 50%
W-2 Managing EmployeeVP of Finance Jan 1, 2013 70%
Earl Thomas Andrews Individual Corporate Officer Jan 1, 2013
Charles Alan Bradford Individual Corporate Officer Jan 1, 2013

Practitioners & affiliated clinicians

Practitioners 46

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 46

NPI Registry JSON

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

{
    "created_epoch": "1237766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237852800000",
    "number": "1821239708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 DECATUR ST SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121848",
            "telephone_number": "678-843-8600",
            "fax_number": "678-843-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 PRYOR ST SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303033638",
            "telephone_number": "678-843-8840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT JOSEPH'S MERCY CARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-23",
        "last_updated": "2009-03-24",
        "status": "A",
        "authorized_official_last_name": "ANDREWS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-843-8503",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "Saint Joseph's Mercy Care - GateWay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.