NPIMap

Organization Active NPI

J.C. Lewis Primary Healthcare Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
National Provider Identifier
1922301472
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
J.C. LEWIS PRIMARY HEALTHCARE CENTER, INC
Practice address
5 Mall Anx
Savannah, GA 31406-4738
Phone
(912) 721-6701
Fax
(912) 495-8881
NPI assigned
Dec 6, 2010
Last updated
Sep 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Authorized official

Name
Dr. Rena DouseNPI 1881220135
Title
Ceo
Phone
(912) 721-6701

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

5 Mall Anx
Savannah, GA 31406-4738

Mailing address

5 Mall Anx
Savannah, GA 31406-4738
Phone (912) 721-6705

Other practice location 1

3802 Waters Ave
Savannah, GA 31404-6210
Phone (912) 352-3845

Other practice location 2

1110 May St
Savannah, GA 31415-5470
Phone (912) 495-8887

Other practice location 3

3100 Montgomery St
Savannah, GA 31405-3212
Phone (912) 495-8887

Other practice location 4

2414 Bull St
Savannah, GA 31401-9113
Phone (912) 495-8887

Other practice location 5

2414 Bull St
Savannah, GA 31401-9113
Phone (912) 495-8887

Other practice location 6

5 Mall Anx
Savannah, GA 31406-4738
Phone (912) 721-6705

Other identifiers 6

IdentifierTypeStateIssuer
003104809AMedicaidGA
003110256AMedicaidGA
003156658AMedicaidGA
003122855AMedicaidGA
003135130AMedicaidGA
003122845AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20130228000232 GA Part A Provider - Federally Qualified Health Center (FQHC) 8426203225 Practice locations: Savannah, GA
O20130824000076 GA Part B Supplier - Clinic/Group Practice 8426203225 Receives reassigned benefits from 21 practitioners
Practice locations: Savannah, GA
O20140409001148 GA Part A Provider - Federally Qualified Health Center (FQHC) 8426203225 1 other NPI on this enrollment
Practice locations: Savannah, GA
O20170707000675 GA Part A Provider - Federally Qualified Health Center (FQHC) 8426203225 Practice locations: Savannah, GA
O20170804002426 GA Part A Provider - Federally Qualified Health Center (FQHC) 8426203225 Practice locations: Savannah, GA

NPI to CCN mapping 6

The Medicare certification numbers (CCNs) connected to NPI 1922301472. Details of each certification follow.

Federally qualified health center certification: CCN 111957

Legal name
J.C. LEWIS PRIMARY HEALTHCARE CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 28, 2013
Last certification
Feb 28, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 16, 2008 in GA
Enrollment address
5 Mall Anx
Savannah, GA 31406-4738

Federally qualified health center certification: CCN 111978

Legal name
J.C. LEWIS PRIMARY HEALTHCARE CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 9, 2014
Last certification
Apr 9, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 16, 2008 in GA
Enrollment address
1110 May St
Savannah, GA 31415-5470

Federally qualified health center certification: CCN 111064

Legal name
J.C. LEWIS PRIMARY HEALTHCARE CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 7, 2017
Last certification
Jul 7, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2011 in GA
Enrollment address
107 Fahm St
Savannah, GA 31401-2391

Federally qualified health center certification: CCN 111065

Legal name
J.C. LEWIS PRIMARY HEALTHCARE CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 4, 2017
Last certification
Aug 4, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2011 in GA
Enrollment address
3802 Waters Ave
Savannah, GA 31404-6210

Federally qualified health center certification: CCN 111961

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
J C LEWIS PRIMARY HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 10, 2013
Last certification
May 10, 2013
Ownership / control type
For profit – corporation
Facility address
3100 Montgomery Street
Savannah, GA 31405

Federally qualified health center certification: CCN 111979

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
J C LEWIS PRIMARY HEALTHCARE CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 9, 2014
Last certification
Apr 9, 2014
Ownership / control type
For profit – corporation
Facility address
2414 Bull Street
Savannah, GA 31401

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1110 May St
Savannah, GA 31415
Phone (912) 495-8887

5 Mall Anx
Savannah, GA 31406
Phone (912) 495-8887

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
Rena M. Douse Individual Corporate Officer Jan 1, 2021
W-2 Managing Employee Jan 1, 2021
J.C. Lewis Primary Healthcare Center, Inc Organization, Savannah, GA Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2011
Operational/Managerial Control Aug 1, 2015 100%
Laura Adams Individual Corporate OfficerChief Financial Officer Dec 27, 2012
W-2 Managing Employee Dec 27, 2012
James B Gaffney Individual 5% Or Greater Indirect Ownership Interest Oct 24, 2016
Operational/Managerial ControlCeo Oct 24, 2016
Corporate OfficerCeo Oct 24, 2016 100%
Operational/Managerial ControlCeo Oct 24, 2016 100%

Owners & managing parties with NPI records 1

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

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1291593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725580800000",
    "number": "1922301472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MALL ANX",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314064738",
            "telephone_number": "912-721-6705",
            "fax_number": "912-495-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MALL ANX",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314064738",
            "telephone_number": "912-721-6701",
            "fax_number": "912-495-8881"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3802 Waters Ave",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314046210",
            "country_code": "US",
            "telephone_number": "912-352-3845",
            "fax_number": "912-354-1980",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1110 May St",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314155470",
            "country_code": "US",
            "telephone_number": "912-495-8887",
            "fax_number": "912-495-8881",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3100 Montgomery St",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314053212",
            "country_code": "US",
            "telephone_number": "912-495-8887",
            "fax_number": "912-495-8881",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2414 Bull St",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314019113",
            "country_code": "US",
            "telephone_number": "912-495-8887",
            "fax_number": "912-495-8881",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2414 Bull St",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314019113",
            "country_code": "US",
            "telephone_number": "912-495-8887",
            "fax_number": "912-495-8881",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 Mall Anx",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314064738",
            "country_code": "US",
            "telephone_number": "912-721-6705",
            "fax_number": "912-233-2057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "J.C. LEWIS PRIMARY HEALTHCARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-06",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "DOUSE",
        "authorized_official_first_name": "RENA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-721-6701",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003104809A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003110256A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003156658A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003122855A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003135130A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003122845A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.