NPIMap

Organization Active NPI

Curtis V. Cooper Primary Health Care Inc.

  • Federally Qualified Health Center (FQHC)
  • Pembroke, GA
National Provider Identifier
1841804598
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CURTIS V. COOPER PRIMARY HEALTH CARE INC.
Practice address
244 Ledford Street
Pembroke, GA 31321-3140
Phone
(912) 527-1100
NPI assigned
Sep 1, 2020
Last updated
Apr 30, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CURTIS V. COOPER PRIMARY HEALTH CARE INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Authorized official

Name
Earlene Joiner Daniels
Title
Ceo
Phone
(912) 527-1088

Specialties & licenses 1

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

Addresses

Primary practice location

244 Ledford Street
Pembroke, GA 31321-3140

Mailing address

106 E Broad St
Savannah, GA 31401-2917
Phone (912) 527-1100

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL Pembroke Health Information Exchange (HIE)
Other URL Savannah Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040609000352 GA Part B Supplier - Clinic/Group Practice 4789667015 Receives reassigned benefits from 77 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Savannah, GA; Prembroke, GA
O20210205001250 GA Part A Provider - Federally Qualified Health Center (FQHC) 4789667015 Practice locations: Pembroke, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841804598. Details of each certification follow.

Federally qualified health center certification: CCN 111139

Legal name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 5, 2021
Last certification
Feb 5, 2021
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 15, 1981 in GA
Enrollment address
244 Ledford St
Pembroke, GA 31321-4587

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Westside Urban Health D20 organizations share this tax ID, including this one
Part of
Westside Urban Health D

Other organizations with this tax ID 19

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

View all 19

Locations

244 Ledford St
Pembroke, GA 31321
Phone (912) 527-1100

244 Ledford St
#100
Pembroke, GA 31321

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
Paul Mosley Individual Corporate Director Jan 1, 2019
Juliet Wade Individual Corporate Director Jun 1, 2018
Richard Shinhoster Individual Corporate Director Jan 1, 2020
Larry Jackson Individual Corporate Director Jan 1, 2021
Albert Grandy Individual Corporate OfficerCeo Jan 1, 2018
Earlene J Daniels Individual Corporate Director Jan 1, 2013 100%
W-2 Managing Employee Jan 1, 2018
Tomas Figueroa Individual Corporate Officer Jan 1, 2018
Helen Stone Individual Corporate Director Jan 1, 2020
Reginald Franklin Individual Corporate Director Jan 1, 2019
Roy Devonne Flood Individual Corporate Director Jan 1, 2017
Mary Hill Individual Corporate Director Jan 1, 2021

Owners & managing parties with NPI records 1

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

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": "1619740800000",
    "number": "1841804598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 E BROAD ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314012917",
            "telephone_number": "912-527-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 LEDFORD STREET",
            "city": "PEMBROKE",
            "state": "GA",
            "postal_code": "313213140",
            "telephone_number": "912-527-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CURTIS V. COOPER PRIMARY HEALTH CARE INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CURTIS V. COOPER PRIMARY HEALTH CARE INC.",
        "enumeration_date": "2020-09-01",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-01",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "EARLENE",
        "authorized_official_middle_name": "JOINER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-527-1088"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Pembroke",
            "affiliation": "N",
            "endpointDescription": "location",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "244 Ledford Street",
            "address_2": "100",
            "city": "Pembroke",
            "state": "GA",
            "country_code": "US",
            "postal_code": "314013140",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Savannah",
            "affiliation": "N",
            "endpointDescription": "FQHC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "244 Ledford Street",
            "city": "Pembroke",
            "state": "GA",
            "country_code": "US",
            "postal_code": "313213140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pembroke, GA

Sources for this page

Verify at the official NPI Registry.