NPIMap

Organization Active NPI

Northern Hospital of Surry County

Doing business as Northern Obstetrics & Gynecology

  • Obstetrics & Gynecology Physician
  • Mount Airy, NC
National Provider Identifier
1043061559
Registry record updated May 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
NORTHERN HOSPITAL OF SURRY COUNTY
Doing business as
Northern Obstetrics & Gynecology
Practice address
510 S South St
Mount Airy, NC 27030-4422
Phone
(336) 786-4522
Fax
(336) 789-3025
NPI assigned
Apr 1, 2024
Last updated
May 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2026

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

Authorized official

Name
Rachel Hiatt
Title
Director, Central Billing
Phone
(336) 783-8452

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

510 S South St
Mount Airy, NC 27030-4422

Mailing address

PO Box 1267
Mount Airy, NC 27030-1267
Phone (336) 719-7112

Other names 1

  • Northern Obstetrics & Gynecology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170911002297 NC Part B Supplier - Clinic/Group Practice 0244281749 Receives reassigned benefits from 49 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Airy, NC; Dobson, NC; Elkin, NC
O20241014003528 NC Part A Provider - Rural Health Clinic 0244281749 Practice locations: Mount Airy, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043061559. Details of each certification follow.

Rural health clinic certification: CCN 343480

Legal name
NORTHERN HOSPITAL OF SURRY COUNTY
Doing business as
NORTHERN OBSTETRICS & GYNECOLOGY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 11, 2024
Last certification
Dec 11, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
510 S South St
Mount Airy, NC 27030-4422
Related CCNs
340003

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Northern Home Care13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

1900 S State College Blvd
Ste 600
Anaheim, CA 92806
Phone (714) 688-3597

105 N Crutchfield St
Dobson, NC 27017
Phone (336) 783-8100

314 S South St
Mount Airy, NC 27030
Phone (336) 719-0011

15397 Fancy Gap Hwy
Ste 2
Cana, VA 24317
Phone (275) 755-4766

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Northern Hospital of Surry County Organization, Mount Airy, NC Corporation, Non-profit Operational/Managerial Control Jan 1, 1966 100%
Derek White Individual Corporate DirectorDirector, Operational Finance Jan 1, 1996 100%
Operational/Managerial ControlDirector, Operational Finance Jan 1, 1996 100%
Andrea Hickling Individual Corporate OfficerCfo Aug 1, 2013 100%

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mountain Valley Hospice & Palliative CareDobson, NC, CCN 341546 Hospice 5% Or Greater Direct Ownership Interest (50%) Oct 1, 2005
Mountain Valley Hospice & Palliative CareGalax, VA, CCN 491580 Hospice 5% Or Greater Direct Ownership Interest (50%) Oct 1, 2005
Northern PediatricsMount Airy, NC, CCN 343481 Rural health clinic Operational/Managerial Control (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779840000000",
    "number": "1043061559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1267",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270301267",
            "telephone_number": "336-719-7112",
            "fax_number": "336-786-3752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 S SOUTH ST",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270304422",
            "telephone_number": "336-786-4522",
            "fax_number": "336-789-3025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN HOSPITAL OF SURRY COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-01",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A",
        "authorized_official_last_name": "HIATT",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "DIRECTOR, CENTRAL BILLING",
        "authorized_official_telephone_number": "336-783-8452"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Obstetrics & Gynecology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Airy, NC

Sources for this page

Verify at the official NPI Registry.