DLP Central Carolina Medical Group LLC
Organization Active NPI Rural Health Clinic/Center · Sanford, NC
NPI 1003508367 · NPPES record last updated Sep 27, 2024
Key facts
- NPI
- 1003508367
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- DLP CENTRAL CAROLINA MEDICAL GROUP LLC
- Practice address
- 1140 Carthage St Ste B
Sanford, NC 27330-4161 - Phone
- (919) 775-2304
- Fax
- (919) 775-4050
- NPI assigned
- May 24, 2023
- Organization subpart
- No
Authorized official
- Name
- Charlotte Lawrence
- Title
- Secretary
- Phone
- (615) 920-7000
Owners & managing parties with NPI records 2
Other NPIs on the same Medicare enrollment 14
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 10
Member of 1
Facilities with the same owner 202
Practitioners 38
-
Anastasia Dolgovskij, P.A.
-
Cheri Walls Folk, NP-C
-
Eyra Adjoa Agudu, MD
-
Nilesh Bhargav, MD
-
Daphne Joan Cates, M.D.
-
Sally J Chapin, FNP
-
Holly Anne Drake, CNM
-
Roger Charles Ernest, D.O.
-
Ken-Shih Fan, DO
-
Michele Imogene Hensley, M.D.
-
Colleen Karson Higdon, WHNP-BC
-
William John Horan, M.D.
-
Kevin Paul Khoudary, M.D.
-
Danielle Nicole McLean, FNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D1035034 | Central Carolina Family Care South | Certificate of waiver | Jan 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Rural health clinic certification: CCN 348976
- Legal name
- DLP CENTRAL CAROLINA MEDICAL GROUP LLC
- Doing business as
- CENTRAL CAROLINA FAMILY CARE SOUTH
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 27, 2023
- Last certification
- Dec 27, 2023
- Ownership / control type
- 1B
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 18, 2016 in DE
- Enrollment address
- 1140 Carthage St
Ste B
Sanford, NC 27330-4161
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Lifepoint Holdings 2 LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 97% |
| DLP Central NC Holding Company LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 100% |
| Pamela Kane |
Corporate Officer |
Jul 1, 2023 | |
| DSB Acquisition LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 97% |
| Laura C Hinson |
Corporate Officer |
Mar 12, 2025 | |
| Lifepoint Hospitals Holdings LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 97% |
| DLP Healthcare LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 100% |
| Historic Lifepoint Hospitals, LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 97% |
| Lifepoint Health Inc |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 97% |
| Charlotte E Lawrence |
Corporate Officer |
Jul 1, 2023 | |
| DLP Partner LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 97% |
| DLP Central Carolina Medical Center LLC |
5% Or Greater Direct Ownership Interest | Jul 1, 2023 | 100% |
| Klaus Michael Boel |
Corporate Officer |
Aug 19, 2024 | |
| W-2 Managing Employee | Aug 19, 2024 | ||
| John Michael Grooms |
Corporate Officer |
Jul 1, 2023 | |
| Christopher J Monte |
Corporate Officer |
Jul 1, 2023 | |
| Legacy Lifepoint Health LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 97% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170503000867 | NC | Part B Supplier - Clinic/Group Practice | 3577840420 |
Receives reassigned benefits from 100 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sanford, NC; Broadway, NC; Pittsboro, NC |
| O20230706001801 | NC | Part a Provider - Rural Health Clinic | 3577840420 | Practice locations: Sanford, NC |
National Provider Directory
- Tax ID family
- Central Carolina Sandhills Family Care
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1140 Carthage St Ste B
Sanford, NC 27330-4161
Mailing address
330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000
Other names
- Central Carolina Family Care South
Other providers in Sanford, NC
- Diaphero Consulting, PLLC
- Janet Dildine
- DLP Central Carolina Family Medicine LLC
- DLP Central Carolina Medical Center LLC
- DLP Central Carolina Medical Center LLC
- DLP Central Carolina Medical Group LLC
- DLP Central Carolina Medical Group LLC
- DLP Central Carolina Medical Group LLC
- DLP Central Carolina Medical Group LLC
- DLP Central Carolina Medical Group LLC
All providers in Sanford, NC · Rural Health Clinic/Center in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.