Bladen Healthcare LLC
Organization Active NPI Rural Health Clinic/Center · Elizabethtown, NC
NPI 1114269677 · NPPES record last updated Nov 19, 2023
Key facts
- NPI
- 1114269677
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- H0154 (NC)
- Legal business name
- BLADEN HEALTHCARE LLC
- Practice address
- 107 E Dunham St
Elizabethtown, NC 28337-4300 - Phone
- (910) 862-2122
- Fax
- (910) 862-1279
- NPI assigned
- Mar 22, 2013
- Organization subpart
- No
Authorized official
- Name
- Joseph B Fiser
- Title
- VP Rev Cycle/Managed Care Planning
- Phone
- (910) 615-5572
Owners & managing parties with NPI records 16
-
Bradley James Broussard, M.D.
-
Samuel Fleishman, MD
-
Myron Scott Strickland, M.D.
Other NPIs on the same Medicare enrollment 14
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 9
Member of 1
Related certifications (CCN) 1
Facilities with the same owner 14
Practitioners 47
-
Briana Gayle Graham, PA-C
-
Brittany Priest Lindsay, FNP-C
-
Kaye B Allen, CRNA
-
Robyn Grice Allen, FNP-C
-
Peggy S Barnhill, MD
-
Martin J Berger, M.D.
-
William Dean Beutel, M.D.
-
Shelley Yvonne Brown, NP-C
-
Temple Britt Byrd, FNP
-
Kathryn Carter, FNP-BC
-
Candice Renee Dowd, CRNA
-
Amber Eddy, AGNP
-
Stephanie Gooden, PA-C
-
Shaun C. Hines, DO
-
Olajumoke Ladapo, MD
-
Angie Evans Lowry, FNP
-
Ashley B Marlowe, FNP
-
Heather W Pait, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2031203 | Bladen Medical Associates Express Care | Certificate of waiver | Oct 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Rural health clinic certification: CCN 343449
- Legal name
- BLADEN HEALTHCARE LLC
- Doing business as
- CFV BMA EXPRESS CARE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 29, 2014
- Last certification
- Aug 9, 2018
- Ownership / control type
- 2B
- Organization structure
- LLC · Non-profit
- Incorporated
- Mar 20, 2008 in NC
- Enrollment address
- 107 East Dunham Street
Elizabethtown, NC 28337-9037 - Related CCNs
- 341315
All disclosed owners & managing parties 23
| Name | Role | Since | Share |
|---|---|---|---|
| Chukwuemeka O Chima |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Jeannette Council |
Corporate Director |
Jun 1, 2008 | |
| Ryan Aul |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Michael Reesal Jones |
W-2 Managing Employee |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Cumberland County Hospital System Inc |
5% Or Greater Direct Ownership Interest | Jun 1, 2008 | 100% |
| Glenn Adams |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Michael Boose |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Amy H Cannon |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Girum K Feyissa |
W-2 Managing Employee |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Tammy Thurman |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Michael Nagowski |
Corporate Director |
Jun 1, 2008 | |
| Bret Johnson |
W-2 Managing Employee |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Myron Scott Strickland |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Joseph Fiser |
Corporate Director |
Jul 21, 2021 | |
| W-2 Managing Employee |
Jul 21, 2021 | ||
| Charles Evans |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Larry Lancaster |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| William Faircloth |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Warren McDonald |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Samuel a Fleishman |
W-2 Managing Employee |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| James Keefe |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Murtis Worth |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Toni Stewart |
Corporate Officer |
Jul 29, 2022 | |
| Operational/Managerial Control |
Jul 29, 2022 | ||
| Bradley J Broussard |
Corporate Director |
Oct 31, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
| O20130712000530 | NC | Part a Provider - Rural Health Clinic | 6800967969 | Practice locations: Elizabethtown, NC |
National Provider Directory
- Tax ID family
- Bladen Healthcare LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | H0154 | NC | Yes |
Addresses
Primary practice location
107 E Dunham St
Elizabethtown, NC 28337-4300
Mailing address
PO Box 40908
Fayetteville, NC 28309-0908
Phone (918) 862-2122
Other names
- Bladen Express Care
Other providers in Elizabethtown, NC
- Bladen County Hospital
- Bladen County Hospital
- Bladen County Schools
- Bladen East Health and Rehab LLC
- Bladen Eye Center OD PLLC
- Bladen Healthcare LLC
- Bladen Healthcare LLC
- Bladen Healthcare LLC
- Bladen Healthcare LLC
- Bladen Healthcare, LLC
All providers in Elizabethtown, 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 Nov 19, 2023. 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.