NPIMap

Organization Active NPI

Saint Joseph's Mercy Care Services Inc

  • Federally Qualified Health Center (FQHC)
  • Atlanta, GA
National Provider Identifier
1831266618
Registry record updated Apr 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
NOT REQUIRED Issued in GA
Legal business name
SAINT JOSEPH'S MERCY CARE SERVICES INC
Practice address
424 Decatur St SE
Atlanta, GA 30312-1848
Phone
(404) 880-3550
Fax
(404) 880-3578
NPI assigned
Nov 29, 2006
Last updated
Apr 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2008

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

Authorized official

Name
Mr. E Thomas Andrews
Title
President
Phone
(404) 880-3559

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NOT REQUIRED GA Primary

Addresses

Primary practice location

424 Decatur St SE
Atlanta, GA 30312-1848

Mailing address

424 Decatur St SE
Atlanta, GA 30312-1848
Phone (404) 880-3550

Other identifiers 1

IdentifierTypeStateIssuer
00649844AMedicaidGA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040401001771 GA Part A Provider - Federally Qualified Health Center (FQHC) 9931191525 Practice locations: Atlanta, GA
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831266618. Details of each certification follow.

Federally qualified health center certification: CCN 111827

Legal name
SAINT JOSEPH'S MERCY CARE SERVICES INC
Doing business as
SAINT JOSEPHS MERCY CARE DECATUR STREET
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1993
Last certification
Oct 1, 1993
Ownership / control type
For profit – corporation
Most recent change of ownership
May 1, 1995 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Nov 25, 2005 in GA
Enrollment address
424 Decatur Sest
Atlanta, GA 30312-1848

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
St Josephs Mercy Care S13 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

1976 Flat Shoals Rd SE
Ste B
Atlanta, GA 30316
Phone (404) 952-1201

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

5134 Peachtree Rd
Chamblee, GA 30341
Phone (678) 872-7100

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 Corporate OfficerVP Finance Jan 26, 2005 50%
W-2 Managing EmployeeVP Finance Jan 1, 2012 50%
Earl Thomas Andrews Individual Corporate OfficerPresident Jan 26, 2005 50%
W-2 Managing EmployeeVP Finance Jan 1, 2012 50%
Charles Alan Bradford Individual Corporate OfficerV.P. Operations/Coo Jul 30, 2012 50%
W-2 Managing EmployeeV.P. Operations/Coo Jul 30, 2012 50%

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1831266618",
    "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": "404-880-3550",
            "fax_number": "404-880-3578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 DECATUR ST SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121848",
            "telephone_number": "404-880-3550",
            "fax_number": "404-880-3578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT JOSEPH'S MERCY CARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "ANDREWS",
        "authorized_official_first_name": "E THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-880-3559",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "GA",
            "license": "NOT REQUIRED",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00649844A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.