NPIMap

Organization Active NPI

The Sylacauga Health Care Authority

Doing business as Davis Family Medicine

  • Rural Health Clinic/Center
  • Sylacauga, AL
National Provider Identifier
1861178733
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
THE SYLACAUGA HEALTH CARE AUTHORITY
Doing business as
Davis Family Medicine
Practice address
209 West Spring St, Ste 102
Sylacauga, AL 35150
Phone
(256) 401-4686
NPI assigned
Jun 26, 2023
Last updated
Jun 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

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

Authorized official

Name
Brad McCormick
Title
Chief Financial Officer
Phone
(256) 401-4534

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

209 West Spring St, Ste 102
Sylacauga, AL 35150

Mailing address

209 West Spring St, Ste 102
Sylacauga, AL 35150
Phone (256) 401-4686

Other names 1

  • Davis Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230726002443 AL Part A Provider - Rural Health Clinic 5294710398 Practice locations: Sylacauga, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861178733. Details of each certification follow.

Rural health clinic certification: CCN 018506

Legal name
THE SYLACAUGA HEALTH CARE AUTHORITY
Doing business as
DAVIS FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 4, 2024
Last certification
Jun 4, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 20, 1988 in AL
Enrollment address
209 W Spring St
Ste 102
Sylacauga, AL 35150-2974
Related CCNs
010164

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2001064Davis Family Medicine209 West Spring Street Suite 102, Sylacauga, AL 35150Certificate of waiverDec 10, 2027

National Provider Directory

National Provider Directory
Tax ID family
Sylacauga Health Care Authority Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

209 W Spring St
Ste 102
Sylacauga, AL 35150
Phone (256) 401-4686

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Jesse L. Cleveland Individual Corporate DirectorBoard Member Jul 1, 2023
Mamoun R Pacha Individual Corporate DirectorBoard Member Jul 1, 2023
Jerry Leonard Fielding Individual Corporate DirectorBoard Member Jul 1, 2023
Stephen R Bowen Individual Corporate DirectorBoard Member Jul 1, 2023
Glenn Chamblee Sisk Individual Corporate OfficerChief Executive Officer Jul 1, 2023
W-2 Managing EmployeeChief Executive Officer Jul 1, 2023
John Floyd Individual Corporate DirectorBoard Member Jul 1, 2023
Shirley Spears Individual Corporate DirectorBoard Member Jul 1, 2023
Wayne Hall Individual Corporate DirectorBoard Member Jul 1, 2023
William McCormick Individual Corporate OfficerChief Financial Officer Jul 1, 2023
W-2 Managing EmployeeChief Financial Officer Jul 1, 2023

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Coosa Valley HospiceSylacauga, AL, CCN 011661 Hospice 5% Or Greater Direct Ownership Interest Mar 8, 2007
Nix Family MedicineChildersburg, AL, CCN 018503 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2023
Jul 1, 2023

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687737600000",
    "number": "1861178733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 WEST SPRING ST, STE 102",
            "city": "SYLACAUGA",
            "state": "AL",
            "postal_code": "35150",
            "telephone_number": "256-401-4686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 WEST SPRING ST, STE 102",
            "city": "SYLACAUGA",
            "state": "AL",
            "postal_code": "35150",
            "telephone_number": "256-401-4686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SYLACAUGA HEALTH CARE AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "256-401-4534"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davis Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sylacauga, AL

Sources for this page

Verify at the official NPI Registry.