NPIMap

Organization Active NPI

Community Health Care Systems Inc,

Doing business as Sandersville Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Sandersville, GA
National Provider Identifier
1861666455
Registry record updated Nov 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CARE SYSTEMS INC,
Doing business as
Sandersville Community Health Center
Practice address
616 Ferncrest Dr
Sandersville, GA 31082-1863
Phone
(478) 552-1620
Fax
(478) 864-1288
NPI assigned
Apr 15, 2008
Last updated
Nov 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2011

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

Authorized official

Name
Mrs. Lynn W Price
Title
Insurance/Billing Manager
Phone
(478) 864-3448

Specialties & licenses 1

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

Addresses

Primary practice location

616 Ferncrest Dr
Sandersville, GA 31082-1863

Mailing address

616 Ferncrest Dr
Sandersville, GA 31082-1863
Phone (478) 552-1620

Other identifiers 2

IdentifierTypeStateIssuer
000521023EMedicaidGA
300029381AMedicaidGA

Other names 1

  • SANDERSVILLE COMMUNITY HEALTH CENTER Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040505000153 GA Part B Supplier - Clinic/Group Practice 5890783179 Receives reassigned benefits from 77 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wrightsville, GA; Wrens, GA; Warrenton, GA; Tennille, GA; Sparta, GA; Sandersville, GA; Milledgeville, GA; Macon, GA…
O20090107000114 GA Part A Provider - Federally Qualified Health Center (FQHC) 5890783179 Practice locations: Sandersville, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861666455. Details of each certification follow.

Federally qualified health center certification: CCN 111918

Legal name
COMMUNITY HEALTH CARE SYSTEMS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 6, 2009
Last certification
Feb 6, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 9, 1992 in GA
Enrollment address
616 Ferncrest Dr
Sandersville, GA 31082-1863

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Other NPIs on the same Medicare enrollment 16

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

View all 16

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
11D0263796Community Health Care Systems Incorporate616 Ferncrest Drive, Sandersville, GA 31082Provider-performed microscopyApr 15, 2028

National Provider Directory

National Provider Directory
Tax ID family
Johnson Co Center for Comm20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Cathy Ivey Individual Corporate Director Jan 1, 1993
Atlean Wilcher Individual Corporate Director Jan 1, 1993
Susan Knox Individual Corporate Director Jan 1, 2005
Pat Lyons Individual Corporate Director Jan 1, 2007
Mary Cook Individual Corporate Director Jan 1, 1993
Carla Belcher Individual Corporate Director Apr 13, 1998
W-2 Managing Employee Apr 13, 1998
David Hartley Individual Corporate Director Jan 1, 2005

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Community Health Care Systems, Inc-BaldwinMilledgeville, GA, CCN 111022 Federally qualified health center Operational/Managerial Control Sep 1, 2015
Community Health Care Systems, Inc.Macon, GA, CCN 111112 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 22, 2017
May 22, 2017

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321833600000",
    "number": "1861666455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 FERNCREST DR",
            "city": "SANDERSVILLE",
            "state": "GA",
            "postal_code": "310821863",
            "telephone_number": "478-552-1620",
            "fax_number": "478-864-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 FERNCREST DR",
            "city": "SANDERSVILLE",
            "state": "GA",
            "postal_code": "310821863",
            "telephone_number": "478-552-1620",
            "fax_number": "478-864-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE SYSTEMS INC,",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-15",
        "last_updated": "2011-11-21",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "INSURANCE/BILLING MANAGER",
        "authorized_official_telephone_number": "478-864-3448",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000521023E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300029381A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SANDERSVILLE COMMUNITY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandersville, GA

Sources for this page

Verify at the official NPI Registry.