Tri County Community Health Council Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Dublin, NC
NPI 1124158043 · NPPES record last updated Mar 27, 2024
Key facts
- NPI
- 1124158043
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- TRI COUNTY COMMUNITY HEALTH COUNCIL INC
- Practice address
- 73 Dixon Street
Dublin, NC 28332-8903 - Phone
- (877) 935-5255
- Fax
- (910) 236-2118
- NPI assigned
- Mar 7, 2007
- Organization subpart
- No
Authorized official
- Name
- William C Ellison
- Title
- Revenue Cycle Manager
- Phone
- (910) 567-7065
Other NPIs on the same Medicare enrollment 19
Other NPIs with the same Medicare PAC ID 15
Corporate family (same tax ID) 24
Practitioners 33
-
Cynthia C Akpaka, DNP,APRN, FNP, PMHNP
-
Sampson Ray Booth, PA-C
-
Andrea Ann-Marie Bound, LCSW-A, LCASA
-
Octavio Cieza, M.D.
-
Quinton Edwards, PA-C
-
Nicole Rouse Glenn, FNP-C
-
Amanda Green, PA-C
-
Lauren Kirsten Johnson, PA-C
-
Saray Lopez, PA-C
-
Ann Harmon Lynch, PA
-
Heidi Ann Schroeder, FNP
-
Anna Leigh Seuser, PA-C
-
Shraddha Sharma, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Federally qualified health center certification: CCN 341907
- Legal name
- TRI COUNTY COMMUNITY HEALTH COUNCIL INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 18, 2022
- Last certification
- Nov 18, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 21, 1977 in NC
- Enrollment address
- 73 Dixon Street
Dublin, NC 28332-8903
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Nancy J Blackman |
Corporate Director |
Jul 14, 2021 | |
| Phillip E Mills |
Corporate Director |
Jul 14, 2021 | |
| Vanessa a Burgess |
Corporate Director |
Jul 14, 2021 | |
| Raymond Lindsey |
Corporate Director |
Jul 14, 2021 | |
| Kenneth a Cabral |
Corporate Director |
Jul 14, 2021 | |
| Nathan J Tilghman |
Corporate Director |
Jul 14, 2021 | |
| Mary Crumpler |
Corporate Director |
Jul 14, 2021 | |
| Silvia a. Cendejas |
Corporate Director |
Jul 14, 2021 | |
| Spencer McAlpine |
Corporate Director |
Jul 14, 2021 | |
| William Taylor |
Corporate Director |
Jul 14, 2021 | |
| Jose Garcia |
Corporate Director |
Jul 14, 2021 | |
| Pamela Tripp |
Corporate Officer |
Sep 21, 2009 | |
| Corporate Director |
Sep 21, 2009 | ||
| W-2 Managing Employee |
Sep 21, 2009 | ||
| Operational/Managerial Control |
Sep 21, 2009 | ||
| Mary E Blaizes |
Corporate Director |
Jul 14, 2021 | |
| William C Ellison |
Corporate Officer |
Mar 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040702000780 | NC | Part B Supplier - Clinic/Group Practice | 2163409558 |
Receives reassigned benefits from 52 practitioners 19 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Willard, NC; Tar Heel, NC; Smithfield, NC; Shallotte, NC; Dunn, NC; Salemburg, NC; Ocean Isle Beach, NC; Harrells, NC… |
| O20221118000426 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 2163409558 | Practice locations: Dublin, NC |
National Provider Directory
- Tax ID family
- Lucy J Brown
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
73 Dixon Street
Dublin, NC 28332-8903
Mailing address
PO Box 340
Four Oaks, NC 27524-0340
Phone (910) 567-6194
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 344001D | Medicaid | NC |
Other names
- CommWell Health at Dublin
Other providers in Dublin, NC
- Rebecca Faye Hehl
- Sonja Durden Hilburn
- Gregory Carl Hohl Sr.
- Hollis Lee Jones
- Stephanie A Miller-Greer
All providers in Dublin, NC · Federally Qualified Health Center (FQHC) 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 Mar 27, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.