DLP Rutherford Physician Practices LLC
Organization Active NPI Rural Health Clinic/Center · Mooresboro, NC
NPI 1063196327 · NPPES record last updated Sep 16, 2024
Key facts
- NPI
- 1063196327
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- DLP RUTHERFORD PHYSICIAN PRACTICES LLC
- Practice address
- 605 NC 120 Hwy
Mooresboro, NC 28114-6713 - Phone
- (828) 453-0703
- Fax
- (828) 453-8035
- NPI assigned
- Jun 14, 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 6
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 3
Member of 1
Facilities with the same owner 202
Practitioners 39
-
Hannah Bennett Beam, DNP, RN, FNP-BC
-
Charles Dana Bond, M.D.
-
Sarah Gibbs Carpenter, FNP-C
-
Andrew Demeusy, M.D.
-
Macey Bright Dunn, FNP
-
Jason Phillip Glover, DPM
-
Gregory Wayne Goodwin, PHYSICIAN ASSISTANT
-
Brian Paul Hearon, M.D.
-
Keith Todd Hill, PA-C
-
Tina Marie Almas Hill, PA-C
-
Mathukutty Joseph, M.D.
-
Cameron Ludwig, MD
-
Genevieve Morales, FNP
-
Jennifer Suggs Robbins, PMHNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0935896 | Rutherford East Family Care | Provider-performed microscopy | Mar 7, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Rural health clinic certification: CCN 348986
- Legal name
- DLP RUTHERFORD PHYSICIAN PRACTICES LLC
- Doing business as
- RUTHERFORD EAST FAMILY CARE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 23, 2024
- Last certification
- Jan 23, 2024
- Ownership / control type
- 1B
- Organization structure
- LLC · Proprietary
- Incorporated
- Mar 14, 2014 in DE
- Enrollment address
- 605 NC 120 Hwy
Mooresboro, NC 28114-6713
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Lifepoint Holdings 2 LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 97% |
| 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% |
| DLP Rutherford Regional Health System, LLC |
5% Or Greater Direct Ownership Interest | Jul 1, 2023 | 100% |
| Charlotte E Lawrence |
Corporate Officer |
Jul 1, 2023 | |
| DLP Partner LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 97% |
| 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 |
|---|---|---|---|---|
| O20140724001507 | NC | Part B Supplier - Clinic/Group Practice | 0345466561 |
Receives reassigned benefits from 85 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Columbus, NC; Rutherfordton, NC; Mooresboro, NC; Forest City, NC |
| O20230712002471 | NC | Part a Provider - Rural Health Clinic | 0345466561 | Practice locations: Mooresboro, NC |
National Provider Directory
- Tax ID family
- DLP Rutherford Physician
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
605 NC 120 Hwy
Mooresboro, NC 28114-6713
Mailing address
330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000
Other names
- Rutherford East Family Care
Other providers in Mooresboro, NC
- Betty J Cooper
- BJS Family Care Home # 2
- Champion Family Care Home
- Country Living and More Family Care
- Macey Bright Dunn
- Duranova Management LLC
- Foothills Harvest Transitional Services, Inc
- Golden Wings Transportation LLC
- Haam Upstate SC, LLC
All providers in Mooresboro, 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 16, 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.