NPIMap

Organization Active NPI

Poarch Band of Creek Indians

Doing business as Poarch Creek Indian Health Department

  • Federally Qualified Health Center (FQHC)
  • Atmore, AL
National Provider Identifier
1902916489
Registry record updated May 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
POARCH BAND OF CREEK INDIANS
Doing business as
Poarch Creek Indian Health Department
Practice address
429 Buford L Rolin Dr
Atmore, AL 36502-5186
Phone
(251) 368-9136
NPI assigned
Aug 30, 2006
Last updated
May 23, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2017

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

Authorized official

Name
Mrs. Teresa SmithNPI 1548510712
Title
Business Office Director
Phone
(251) 368-9136

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

429 Buford L Rolin Dr
Atmore, AL 36502-5186

Mailing address

5811 Jack Springs Rd
Atmore, AL 36502-5025
Phone (251) 368-9136

Other identifiers 2

IdentifierTypeStateIssuer
0130574OtherNCPDP
630000019MedicaidAL

Other names 1

  • Poarch Creek Indian Health Department Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20150203002035 TX Part B Supplier - Clinic/Group Practice 9830188085 Receives reassigned benefits from 35 practitioners
Practice locations: Atmore, AL
O20150213001507 AL Part A Provider - Federally Qualified Health Center (FQHC) 9830188085 Practice locations: Atmore, AL
O20170913002022 TX Part B Supplier - Independent Clinical Laboratory 9830188085 Practice locations: Atmore, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902916489. Details of each certification follow.

Federally qualified health center certification: CCN 011020

Legal name
POARCH BAND OF CREEK INDIANS
Doing business as
POARCH CREEK INDIANS HEALTH DEPARTMENT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 12, 2015
Last certification
Feb 12, 2015
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
429 Buford L Rolin Dr
Atmore, AL 36502-5190

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
01D0671486Poarch Band of Creek Indians Health Department Lab429 Buford L Rolin Drive, Atmore, AL 36502ComplianceJun 14, 2028

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

517 Martin Rd
Atmore, AL 36502
Phone (251) 368-9136

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/148f5931-d9cf-4d65-8c66-7021ed161b73/

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Teresa Smith Individual W-2 Managing EmployeeBusiness Office Director Apr 1, 2014 100%
Operational/Managerial ControlBusiness Office Director Apr 1, 2014 100%
Katherine Meyer Individual Corporate DirectorRevenue Cycle Director Nov 1, 2021
W-2 Managing EmployeeRevenue Cycle Director Nov 1, 2021
Kelly Dirting Individual Corporate DirectorHealth Director Jul 1, 2016
W-2 Managing EmployeeHealth Director Jul 1, 2016
Operational/Managerial ControlHealth Director Jul 1, 2016
Poarch Band of Creek Indians Organization, Atmore, AL 5% Or Greater Direct Ownership Interest May 1, 2014 100%

Practitioners & affiliated clinicians

Practitioners 37

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 37

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495497600000",
    "number": "1902916489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5811 JACK SPRINGS RD",
            "city": "ATMORE",
            "state": "AL",
            "postal_code": "365025025",
            "telephone_number": "251-368-9136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 BUFORD L ROLIN DR",
            "city": "ATMORE",
            "state": "AL",
            "postal_code": "365025186",
            "telephone_number": "251-368-9136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POARCH BAND OF CREEK INDIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2017-05-23",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "251-368-9136",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0130574",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630000019",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poarch Creek Indian Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atmore, AL

Sources for this page

Verify at the official NPI Registry.