NPIMap

Organization Active NPI

First Choice Primary Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Macon, GA
National Provider Identifier
1952052086
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FIRST CHOICE PRIMARY CARE, INC
Practice address
400 Poplar St
Macon, GA 31201-3336
Phone
(478) 787-4266
NPI assigned
Jan 11, 2022
Last updated
Jan 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Authorized official

Name
Tracy Smith
Title
Director of Accounting
Phone
(478) 787-4266

Specialties & licenses 1

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

Addresses

Primary practice location

400 Poplar St
Macon, GA 31201-3336

Mailing address

PO Box 4363
Macon, GA 31208-4363

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220310000274 GA Part A Provider - Federally Qualified Health Center (FQHC) 6103907316 Practice locations: Macon, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952052086. Details of each certification follow.

Federally qualified health center certification: CCN 851161

Legal name
FIRST CHOICE PRIMARY CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 1, 2022
Last certification
Mar 1, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 27, 2005 in GA
Enrollment address
400 Poplar St
Macon, GA 31201-3336

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
First Choice Primary Care Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Mable Wheeler Individual Corporate DirectorBoard Member Jul 1, 2007 7.14%
Camille Hope Individual Corporate DirectorBoard Member Jul 1, 2007 7.18%
Thomas Duval Individual Corporate DirectorBoard Member Jun 21, 2008 7.14%
Elbert McQueen Individual Corporate DirectorBoard Member Apr 23, 2015 7.14%
David C Parish Individual Corporate DirectorBoard Member Jul 1, 2007 7.14%
Marvin Riggins Individual Corporate DirectorBoard Member Sep 24, 2011 7.14%
Jonathan Alderman Individual Corporate DirectorBoard Member Jul 1, 2007 7.14%
Katherine McLeod Individual Corporate OfficerCeo Nov 1, 2007
W-2 Managing EmployeeChief Executive Officer Nov 1, 2007 7.14%
Operational/Managerial ControlCeo Nov 1, 2007
Linda Holland Individual Corporate DirectorBoard Member Jun 21, 2008 7.14%
Steven Corkery Individual Corporate DirectorBoard Member Sep 24, 2011 7.14%
Roz McMillan Individual Corporate DirectorBoard Member Jul 1, 2007 7.14%
Claudette Slade Individual Corporate OfficerCfo/Coo Jun 28, 2016
W-2 Managing EmployeeCfo/Coo Jun 28, 2016
Operational/Managerial ControlCfo/Coo Jun 28, 2016
Antonio Lewis-Ross Individual Corporate DirectorBoard Member Sep 2, 2021 7.14%
Jill Vanderhoek Individual Corporate DirectorBoard Member Jan 25, 2020 7.14%
Bernice Eboh Individual Corporate DirectorBoard Member Dec 2, 2021 7.14%

Owners & managing parties with NPI records 1

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
First Choice Primary Care, Inc.Macon, GA, CCN 111069 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2007
FCPC Bruce Elementary SBHCMacon, GA, CCN C21039 Federally qualified health center Operational/Managerial Control (100%) May 1, 2025

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": "1641859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1952052086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4363",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312084363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 POPLAR ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013336",
            "telephone_number": "478-787-4266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST CHOICE PRIMARY CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-11",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-07",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "DIRECTOR OF ACCOUNTING",
        "authorized_official_telephone_number": "478-787-4266"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.