NPIMap

Organization Active NPI

Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
National Provider Identifier
1952941528
Registry record updated Jan 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC
Practice address
400 E Broad St
Savannah, GA 31401-5104
Phone
(912) 527-1000
NPI assigned
Jan 13, 2020
Last updated
Jan 13, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CURTIS V. COOPER PRIMARY HEALTH CARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2020

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

Authorized official

Name
Athelstane Seraphin
Title
Cio
Phone
(912) 527-1130

Specialties & licenses 1

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

Addresses

Primary practice location

400 E Broad St
Savannah, GA 31401-5104

Mailing address

106 E Broad St
Savannah, GA 31401-2917

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040609000352 GA Part B Supplier - Clinic/Group Practice 4789667015 Receives reassigned benefits from 77 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Savannah, GA; Prembroke, GA
O20201123001182 GA Part A Provider - Federally Qualified Health Center (FQHC) 4789667015 Practice locations: Savannah, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952941528. Details of each certification follow.

Federally qualified health center certification: CCN 111138

Legal name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 6, 2021
Last certification
Jan 6, 2021
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 10, 2020 in GA
Enrollment address
400 E Broad St
Savannah, GA 31401-5104

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Curtis V Cooper Primary Hea16 organizations share this tax ID, including this one
Part of
Curtis V Cooper Primary Hea

Other organizations with this tax ID 15

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

View all 15

Locations

400 E Broad St
Savannah, GA 31401
Phone (912) 527-1100

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Paul Mosley Individual Corporate DirectorBoard Member Jan 1, 2019
Juliet Wade Individual Corporate DirectorBoard Member Jan 1, 2012
Larry Jackson Individual Corporate DirectorBoard Chair Jan 1, 2014
Albert Grandy Individual Corporate OfficerCeo Dec 15, 2014
Earlene J Daniels Individual Corporate OfficerCfo Jan 1, 2018 100%
Operational/Managerial ControlCfo Jan 1, 2018 100%
Lester Johnson Individual Corporate DirectorBoard Member Jan 1, 2019
Roy Devonne Flood Individual Corporate DirectorBoard Member Jan 1, 2017
Mary Hill Individual Corporate DirectorBoard Member Jan 1, 2021
Ray Truitt Individual Corporate DirectorBoard Member Jan 1, 2020
Deborah Wright Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1578873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578873600000",
    "number": "1952941528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 E BROAD ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314012917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E BROAD ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314015104",
            "telephone_number": "912-527-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CURTIS V. COOPER PRIMARY HEALTH CARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CURTIS V. COOPER PRIMARY HEALTH CARE, INC",
        "enumeration_date": "2020-01-13",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A",
        "authorized_official_last_name": "SERAPHIN",
        "authorized_official_first_name": "ATHELSTANE",
        "authorized_official_title_or_position": "CIO",
        "authorized_official_telephone_number": "912-527-1130"
    },
    "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 Savannah, GA

Sources for this page

Verify at the official NPI Registry.