NPIMap

Organization Active NPI

Kinston Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Kinston, NC
National Provider Identifier
1104859313
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KINSTON COMMUNITY HEALTH CENTER, INC
Practice address
324 N Queen Street
Kinston, NC 28501-4932
Phone
(252) 522-9800
Fax
(252) 523-9790
NPI assigned
Jul 9, 2006
Last updated
Dec 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Authorized official

Name
Mrs. Suzanne Freeman
Title
Chief Executive Officer
Phone
(252) 522-9800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

324 N Queen Street
Kinston, NC 28501-4932

Mailing address

PO Box 2278
Kinston, NC 28502-2278
Phone (252) 522-9800

Other practice location 1

107 S Queen St
Kinston, NC 28501-4933
Phone (252) 522-9800

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040706001352 NC Part B Supplier - Clinic/Group Practice 1254318397 Receives reassigned benefits from 20 practitioners
1 other NPI on this enrollment
Practice locations: Kinston, NC
O20080806000479 NC Part A Provider - Federally Qualified Health Center (FQHC) 1254318397 Practice locations: Kinston, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104859313. Details of each certification follow.

Federally qualified health center certification: CCN 341850

Legal name
KINSTON COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 11, 1995
Last certification
Aug 11, 1995
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 26, 1993 in NC
Enrollment address
324 N Queen St
Kinston, NC 28501-4932

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

107 S Queen St
Kinston, NC 28501
Phone (252) 522-9800

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Mark Hale Individual Corporate Director Jun 1, 2006
Rosalind S McDonald Individual Corporate Director Jun 1, 2007
Vickie Polk Individual W-2 Managing EmployeeBilling Supervisor Jan 1, 2014
Daphne Betts-Hemby Individual Corporate OfficerCfo Apr 23, 2013
Operational/Managerial ControlChief Finacial Officer (Cfo) Apr 23, 2013
Hilda Hill Individual Corporate Director Mar 14, 2006
Temesheia W Bryant Individual W-2 Managing EmployeeHR Generalist Jan 1, 2013
Vincent Jones Individual Corporate Director Jun 1, 2006

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1104859313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2278",
            "city": "KINSTON",
            "state": "NC",
            "postal_code": "285022278",
            "telephone_number": "252-522-9800",
            "fax_number": "252-522-9854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 N QUEEN STREET",
            "city": "KINSTON",
            "state": "NC",
            "postal_code": "285014932",
            "telephone_number": "252-522-9800",
            "fax_number": "252-523-9790"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "107 S Queen St",
            "address_purpose": "LOCATION",
            "city": "Kinston",
            "state": "NC",
            "postal_code": "285014933",
            "country_code": "US",
            "telephone_number": "252-522-9800",
            "fax_number": "252-523-9790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KINSTON COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "252-522-9800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kinston, NC

Sources for this page

Verify at the official NPI Registry.