NPIMap

Organization Active NPI

Rural Health Group, Inc.

Doing business as Rural Health Group at Lake Gaston

  • Federally Qualified Health Center (FQHC)
  • Littleton, NC
National Provider Identifier
1093767535
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL HEALTH GROUP, INC.
Doing business as
Rural Health Group at Lake Gaston
Practice address
108 Mosby Ave
Littleton, NC 27850-9411
Phone
(252) 586-5151
Fax
(252) 586-2028
NPI assigned
May 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Judy Belch Beasley
Title
Corporate Compliance Officer
Phone
(252) 536-5791

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

108 Mosby Ave
Littleton, NC 27850-9411

Mailing address

2064 Hwy 125
P.O. Box 640
Roanoke Rapids, NC 27870-0640
Phone (252) 536-5791

Other identifiers 2

IdentifierTypeStateIssuer
344525MedicaidNC
02153OtherNCBCBS OF NORTH CAROLINA

Other names 1

  • Rural Health Group at Lake Gaston Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050708000124 NC Part B Supplier - Clinic/Group Practice 9739090226 Receives reassigned benefits from 81 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Enfield, NC; Whitakers, NC; Weldon, NC; Stovall, NC; Scotland Neck, NC; Roanoke Rapids, NC; Norlina, NC; Littleton, NC…
O20101015001209 NC Part A Provider - Federally Qualified Health Center (FQHC) 9739090226 Practice locations: Littleton, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093767535. Details of each certification follow.

Federally qualified health center certification: CCN 341893

Legal name
RURAL HEALTH GROUP INC
Doing business as
RURAL HEALTH GROUP AT LAKE GASTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 2, 2005
Last certification
Aug 2, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 4, 1985 in NC
Enrollment address
108 Mosby Ave
Littleton, NC 27850-9411

Other NPIs with the same Medicare PAC ID 18

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

View all 18

Other NPIs on the same Medicare enrollment 17

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

View all 17

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1061582Rural Health Group at Lake Gaston108 N Mosby Avenue, Littleton, NC 27850Provider-performed microscopyNov 20, 2026

National Provider Directory

National Provider Directory

Locations

9425 NC Highway 305
Jackson, NC 27845
Phone (252) 534-1661

108 N Mosby Ave
Littleton, NC 27850
Phone (252) 586-5411

1381 Medical Center Dr
Roanoke Rapids, NC 27870
Phone (252) 535-1414

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Chester Bruce Williams Individual Corporate DirectorBoard Member Mar 8, 2016
Gary Lavern Wingfield Individual Corporate DirectorBoard Member Aug 18, 2019
Krystian Gayle Latham Individual Corporate DirectorBoard Member Feb 24, 2022
Ella Green Viverette Individual Corporate DirectorBoard Member Aug 2, 2005
Jimille Evans Mills Individual Corporate DirectorBoard Member Jan 28, 2021
Patrinia Mitchell Deloatch Individual W-2 Managing EmployeeDelegated Official Apr 22, 2024
Cynthia Lynette Brown Individual Corporate DirectorBoard Member Aug 2, 2005
Yvonne Long Gee Individual Corporate OfficerCeo Jan 27, 2018
Wilhelmena Rae Herritage Mitchell Individual Corporate DirectorBoard Member Aug 2, 2005
Sara Myrick Council Individual Corporate DirectorBoard Member Mar 17, 2019
Clyde Anthony Johnston Individual Corporate DirectorBoard Member Aug 2, 2005
Lutricia Lynch Lewis Individual Corporate DirectorBoard Member Aug 2, 2005
Audrey Lee Hardy Individual Corporate DirectorBoard Member Mar 8, 2016

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Rural Health Group at HendersonHenderson, NC, CCN 341946 Federally qualified health center Operational/Managerial Control Aug 31, 2009
Rural Health Group at EnfieldEnfield, NC, CCN 341002 Federally qualified health center Operational/Managerial Control Jul 2, 2012
Rural Health Group at Halifax Community CollegeWeldon, NC, CCN 341092 Federally qualified health center Operational/Managerial Control Feb 13, 2018
Rural Health Group at Drugco ExpressRoanoke Rapids, NC, CCN 341091 Federally qualified health center Operational/Managerial Control Jul 17, 2018

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 42

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 42

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093767535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2064 HWY 125",
            "address_2": "P.O. BOX 640",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278700640",
            "telephone_number": "252-536-5791",
            "fax_number": "252-536-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 MOSBY AVE",
            "city": "LITTLETON",
            "state": "NC",
            "postal_code": "278509411",
            "telephone_number": "252-586-5151",
            "fax_number": "252-586-2028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BEASLEY",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "BELCH",
        "authorized_official_title_or_position": "CORPORATE COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "252-536-5791",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344525",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NORTH CAROLINA",
            "identifier": "02153",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rural Health Group at Lake Gaston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Littleton, NC

Sources for this page

Verify at the official NPI Registry.