NPIMap

Organization Active NPI

Bladen Healthcare LLC

Doing business as Cape Fear Valley BMA Clarkton

  • Rural Health Clinic/Center
  • Clarkton, NC
National Provider Identifier
1043759335
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BLADEN HEALTHCARE LLC
Doing business as
Cape Fear Valley BMA Clarkton
Practice address
9858 N WR Latham Dr
Clarkton, NC 28433-9341
Phone
(910) 862-1217
Fax
(910) 647-0208
NPI assigned
Feb 20, 2017
Last updated
Jan 15, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
CUMBERLAND COUNTY HEALTH SYSTEM INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Authorized official

Name
Joseph Barton Fiser
Title
VP Corp Revenue and Managed Care
Phone
(910) 615-5572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

9858 N WR Latham Dr
Clarkton, NC 28433-9341

Mailing address

PO Box 40908
Fayetteville, NC 28309-0908

Other names 1

  • Cape Fear Valley BMA Clarkton Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080617000314 NC Part B Supplier - Clinic/Group Practice 6800967969 Receives reassigned benefits from 173 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elizabethtown, NC; Whiteville, NC; Lumberton, NC; Dublin, NC; Clarkton, NC; Bladenboro, NC
O20170331001478 NC Part A Provider - Rural Health Clinic 6800967969 Practice locations: Clarkton, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043759335. Details of each certification follow.

Rural health clinic certification: CCN 343464

Legal name
BLADEN HEALTHCARE LLC
Doing business as
CAPE FEAR VALLEY BLADEN MEDICAL ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 5, 2017
Last certification
Nov 18, 2021
Ownership / control type
2B
Organization structure
LLCNon-profit
Enrollment address
88 E Green St
Clarkton, NC 28433-5003
Related CCNs
341315

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Part of
Melrose Pediatric Care

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Chukwuemeka O Chima Individual Corporate OfficerTrustee Aug 5, 2022
Operational/Managerial ControlTrustee Aug 5, 2022
Jeannette Council Individual Corporate DirectorBoard Member Apr 1, 2017
Ryan Aul Individual Corporate OfficerTrustee Aug 5, 2022
Operational/Managerial ControlTrustee Aug 5, 2022
Cumberland County Hospital System Inc Organization, Fayetteville, NC Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2017 100%
Operational/Managerial Control Apr 1, 2017 100%
Glenn Adams Individual Corporate DirectorBoard Member Apr 1, 2017
Michael Boose Individual Corporate OfficerTrustee Aug 5, 2022
Operational/Managerial ControlTrustee Aug 5, 2022
Amy H Cannon Individual Corporate OfficerTrustee Aug 5, 2022
Operational/Managerial ControlTrustee Aug 5, 2022
Girum K Feyissa Individual W-2 Managing EmployeeTrustee Aug 5, 2022
Operational/Managerial ControlTrustee Aug 5, 2022
Tammy Thurman Individual Corporate OfficerTrustee Aug 5, 2022
Operational/Managerial ControlTrustee Aug 5, 2022
Michael Nagowski Individual Corporate OfficerCeo Apr 1, 2017
W-2 Managing EmployeeCeo Apr 1, 2017
Bret Johnson Individual W-2 Managing EmployeeCfo Aug 5, 2022
Operational/Managerial ControlCfo Aug 5, 2022
Myron Scott Strickland Individual Corporate OfficerTrustee Aug 5, 2022
Operational/Managerial ControlTrustee Aug 5, 2022
Joseph Fiser Individual W-2 Managing EmployeeVice President Apr 1, 2017
Charles Evans Individual Corporate OfficerTrustee Aug 5, 2022
Operational/Managerial ControlTrustee Aug 5, 2022
Larry Lancaster Individual Corporate DirectorBoard Member Apr 1, 2017
William Faircloth Individual Corporate DirectorBoard Member Apr 1, 2017
Warren McDonald Individual Corporate DirectorBoard Member Apr 1, 2017
Samuel a Fleishman Individual W-2 Managing EmployeeMedical Director Aug 5, 2022
Operational/Managerial ControlMedical Director Aug 5, 2022
James Keefe Individual Corporate DirectorBoard Member Apr 1, 2017
Murtis Worth Individual Corporate DirectorBoard Member Apr 1, 2017
Toni Stewart Individual Corporate OfficerTrustee Aug 5, 2022
Operational/Managerial ControlTrustee Aug 5, 2022
Bradley J Broussard Individual Corporate DirectorBoard Member Apr 1, 2017

Owners & managing parties with NPI records 15

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

View all 15

Facilities with the same owner 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 11

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": "1487548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768435200000",
    "number": "1043759335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40908",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283090908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9858 N WR LATHAM DR",
            "city": "CLARKTON",
            "state": "NC",
            "postal_code": "284339341",
            "telephone_number": "910-862-1217",
            "fax_number": "910-647-0208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLADEN HEALTHCARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CUMBERLAND COUNTY HEALTH SYSTEM INC",
        "enumeration_date": "2017-02-20",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A",
        "authorized_official_last_name": "FISER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "BARTON",
        "authorized_official_title_or_position": "VP CORP REVENUE AND MANAGED CARE",
        "authorized_official_telephone_number": "910-615-5572"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cape Fear Valley BMA Clarkton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarkton, NC

Sources for this page

Verify at the official NPI Registry.