Advance Community Health, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Raleigh, NC
NPI 1003528381 · NPPES record last updated Jan 4, 2023
Key facts
- NPI
- 1003528381
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- ADVANCE COMMUNITY HEALTH, INC
- Practice address
- 1315 Oakwood Ave
Raleigh, NC 27610-2247 - Phone
- (919) 833-3111
- NPI assigned
- Dec 19, 2022
- Organization subpart
- No
Authorized official
- Name
- Scot McCray
- Title
- Chief Executive Officer
- Phone
- (919) 833-3111
Other NPIs on the same Medicare enrollment 13
Other NPIs with the same Medicare PAC ID 7
Practitioners 32
-
Fanteema Barnes, LCSW
-
Lauren Maria Boulus, MS, RD, LDN
-
Sheila De Leon Cabalu, DNP, APRN, FNP-C
-
Robert Thomas Dodge, PHD, RN, ANP
-
Ziad Chahine El Tannir, PA-C
-
Christa Martina Fleming, PA-C
-
Aries Hamlet, PA-C
-
Deanna Harris, MD
-
Victoria Lynn Harris, PA-C
-
Heidi Marie Hughes, FNP-C
-
Bryiane Pascua Medina, FNP-BC
-
Jessica Reid, FNP
-
Stephanie Rodman-Agbejule, FNP-C
-
Michelle Lee Stroup, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2281936 | Advance Community Health -St Augustine | Certificate of waiver | May 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Federally qualified health center certification: CCN B61059
- Legal name
- ADVANCE COMMUNITY HEALTH INC
- Doing business as
- ST. AUGUSTINE UNIVERSITY CAREPLEX
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 15, 2024
- Last certification
- Nov 15, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Incorporated
- Apr 20, 1972 in NC
- Enrollment address
- 1315 Oakwood Ave
Raleigh, NC 27610-2247
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Scot McCray |
Corporate Officer |
Feb 1, 2021 | |
| Tonchelle Renee Lucas |
W-2 Managing Employee |
May 15, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040824000695 | NC | Part B Supplier - Clinic/Group Practice | 3577471697 |
Receives reassigned benefits from 91 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wendell, NC; Wake Forest, NC; Raleigh, NC; Louisburg, NC; Apex, NC; Cary, NC; Holly Springs, NC; Fuquay Varina, NC |
| O20241108003357 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 3577471697 | Practice locations: Raleigh, NC |
National Provider Directory
Locations
1001 Rock Quarry Rd
Raleigh, NC 27610
Phone (919) 250-2934
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1315 Oakwood Ave
Raleigh, NC 27610-2247
Mailing address
1001 Rock Quarry Rd
Raleigh, NC 27610-3825
Phone (919) 250-2923
Other names
- St. Augustine University CarePlex
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | https://advancechc.org/contact-us/ |
Other providers in Raleigh, NC
- Ma Farida G. Adoro
- Stephanie A Adrian
- Sankar Naidu Adusumilli
- Advaita Health Ventures LLC
- Advaita Integrated Medicine PLLC
- Advance Community Health, Inc
- Advance Community Health, Inc
- Advance Community Health, Inc
- Advance Community Health, Inc
- Advance Community Health, Inc
All providers in Raleigh, NC · Federally Qualified Health Center (FQHC) 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 Jan 4, 2023. 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.