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East Georgia Healthcare Center, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Swainsboro, GA

NPI 1831144971 · NPPES record last updated Oct 23, 2012

Key facts

NPI
1831144971
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
EAST GEORGIA HEALTHCARE CENTER, INC.
Practice address
215 N Coleman St
Swainsboro, GA 30401-3530
Phone
(478) 237-6262
Fax
(478) 237-9138
NPI assigned
May 24, 2006
Organization subpart
No

Authorized official

Name
Jennie Wren Denmark
Title
Ceo
Phone
(478) 237-6262

Owners & managing parties with NPI records 17

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

Owned or controlled facilities with NPI records 3

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

Other NPIs on the same Medicare enrollment 15

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

Other NPIs with the same Medicare PAC ID 16

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

Facilities with the same owner 1

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

Practitioners 45

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

View all 45

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in GA

Federally qualified health center certification: CCN 111830

Legal name
EAST GEORGIA HEALTHCARE CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1994
Last certification
Oct 1, 1994
Ownership / control type
Non-profit – other
Organization structure
Corporation · Non-profit
Incorporated
May 29, 1992 in GA
Enrollment address
215 N Coleman St
Swainsboro, GA 30401-3530

Federally qualified health center certification: CCN 111977

Legal name
EAST GEORGIA HEALTHCARE CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 2, 2014
Last certification
Apr 2, 2014
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
May 29, 1992 in GA
Enrollment address
1636 Hatch Parkway South
Baxley, GA 31513-4376

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Joel Salgado
Individual 		Corporate Officer Jan 1, 2021 10%
Gwendolyn Love
Individual 		Corporate Director Jan 1, 2008
Corporate Director
Board Member		 Apr 22, 2013 6%
Lynda Morgan
Individual 		Corporate Director Jan 1, 2008
Corporate Director
Chairman		 Apr 22, 2013 6%
Theron D Faison
Individual 		Corporate Director Sep 1, 2009
Corporate Director
Board Member		 Apr 22, 2013 5%
Jennie W Denmark
Individual 		W-2 Managing Employee Jan 1, 2008
W-2 Managing Employee
Ceo		 Apr 22, 2013 6%
Elizabeth Hendrix
Individual 		Corporate Director Jan 1, 2008
Corporate Director
Board Member		 Apr 22, 2013 6%
Cleveland White
Individual 		Corporate Director Jan 1, 2011
Corporate Director
Board Member		 Apr 22, 2013 5%
Martin R Sheldon
Individual 		Corporate Officer
Chief Medical Officer		 Aug 1, 2021 5%
W-2 Managing Employee Aug 1, 2021
Ken Mercer
Individual 		Corporate Officer Mar 1, 2021 10%
Corporate Director
Board Member		 Apr 22, 2013 6%
Luis Machado
Individual 		Corporate Director Jan 1, 2008
Corporate Director
Board Member		 Apr 22, 2013 5%
Amanda R Brown
Individual 		Corporate Director Jan 1, 2008
Corporate Director
Board Member		 Apr 22, 2013 5%
Jill R Sorrells
Individual 		Corporate Officer
Chief Financial Officer		 Jan 1, 2008
W-2 Managing Employee Jan 1, 2008
W-2 Managing Employee
Cfo		 Apr 22, 2013 6%
East Georgia Healthcare Center, Inc.
Organization · Swainsboro, GA
Non-profit 		Operational/Managerial Control Jan 1, 2014 100%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Statesboro Pediatrics and Family Healthcare Center
Statesboro, GA · CCN 111931		 Federally qualified health center Other Mar 12, 2013
East Georgia Healthcare Center, Inc.
Millen, GA · CCN 111063		 Federally qualified health center Operational/Managerial Control May 1, 2017

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050722000569 GA Part B Supplier - Clinic/Group Practice 0547228686 Receives reassigned benefits from 49 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wadley, GA; Vidalia, GA; Sylvania, GA; Swainsboro, GA; Mount Vernon, GA; Stillmore, GA; Statesboro, GA; Soperton, GA…
O20081203000174 GA Part a Provider - Federally Qualified Health Center (FQHC) 0547228686 Practice locations: Swainsboro, GA
O20140402001089 GA Part a Provider - Federally Qualified Health Center (FQHC) 0547228686 1 other NPI on this enrollment
Practice locations: Baxley, GA

National Provider Directory

Locations

1075 E Winthrope Ave
Millen, GA 30442
Phone (478) 237-2638

330 Mims Rd
Sylvania, GA 30467
Phone (912) 451-5887

Specialties & licenses

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

Addresses

Primary practice location

215 N Coleman St
Swainsboro, GA 30401-3530

Mailing address

215 N Coleman St
Swainsboro, GA 30401-3530
Phone (478) 237-6262

Other identifiers

IdentifierTypeStateIssuer
000632376AMedicaidGA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 23, 2012.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350950400000",
    "number": "1831144971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N COLEMAN ST",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013530",
            "telephone_number": "478-237-6262",
            "fax_number": "478-237-9138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N COLEMAN ST",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013530",
            "telephone_number": "478-237-6262",
            "fax_number": "478-237-9138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GEORGIA HEALTHCARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2012-10-23",
        "status": "A",
        "authorized_official_last_name": "DENMARK",
        "authorized_official_first_name": "JENNIE",
        "authorized_official_middle_name": "WREN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "478-237-6262"
    },
    "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": "000632376A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Swainsboro, GA

All providers in Swainsboro, GA · Federally Qualified Health Center (FQHC) in Georgia

Sources for this page

Verify at the official NPI Registry.