NPIMap

Organization Active NPI

East Georgia Healthcare Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Swainsboro, GA
National Provider Identifier
1831144971
Registry record updated Oct 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Oct 23, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2012

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

Authorized official

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

Specialties & licenses 1

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

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA3 enrollments

Enrollment records 3

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

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1831144971. Details of each certification follow.

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
CorporationNon-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
CorporationNon-profit
Incorporated
May 29, 1992 in GA
Enrollment address
1636 Hatch Parkway South
Baxley, GA 31513-4376

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

Locations

6459 US Highway 301
Claxton, GA 30417
Phone (478) 237-6262

Ownership & related parties

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

Owners & managing parties with NPI records 17

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

View all 17

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 CenterStatesboro, 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

Owned or controlled facilities with NPI records 3

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 43

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 43

NPI Registry JSON

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

{
    "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Swainsboro, GA

Sources for this page

Verify at the official NPI Registry.