NPIMap

Organization Active NPI

County of Stanly

  • State or Local Public Health Clinic/Center
  • Albemarle, NC
National Provider Identifier
1124167796
Registry record updated Oct 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
Legal business name
COUNTY OF STANLY
Practice address
1000 N 1St St
Suite 3
Albemarle, NC 28001-2819
Phone
(704) 982-9171
Fax
(704) 982-8354
NPI assigned
Feb 6, 2007
Last updated
Oct 24, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF STANLYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 24, 2018

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

Authorized official

Name
Glenn David Jenkins
Title
Health and Human Services
Phone
(704) 982-9171

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Dental Clinic/Center 261QD0000X
Non-Surgical Family Planning Clinic/Center 261QF0050X NC
Multi-Specialty Clinic/Center 261QM1300X NC
State or Local Public Health Clinic/Center 261QP0905X NC Primary
Primary Care Clinic/Center 261QP2300X
Clinical Medical Laboratory 291U00000X 34D0684540 NC
Clinic Pharmacy 3336C0002X ML0765137 NC

Addresses

Primary practice location

1000 N 1St St
Suite 3
Albemarle, NC 28001-2819

Mailing address

1000 N 1St St
Suite 3
Albemarle, NC 28001-2819
Phone (704) 982-9171

Other identifiers 1

IdentifierTypeStateIssuer
3404384MedicaidNC

Other names 1

  • Stanly Co Hlth Dept - HealthCheck-EPSDT- FP Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190916000665 NC Part B Supplier - Clinic/Group Practice 2466594619 Receives reassigned benefits from 2 practitioners
Practice locations: Albemarle, NC

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Scusa Transportation8 organizations share this tax ID, including this one
Part of
Scusa Transportation

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

201 S 2nd St
Albemarle, NC 28001
Phone (704) 986-3650

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540339200000",
    "number": "1124167796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N 1ST ST",
            "address_2": "SUITE 3",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280012819",
            "telephone_number": "704-982-9171",
            "fax_number": "704-982-8354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N 1ST ST",
            "address_2": "SUITE 3",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280012819",
            "telephone_number": "704-982-9171",
            "fax_number": "704-982-8354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF STANLY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF STANLY",
        "enumeration_date": "2007-02-06",
        "last_updated": "2018-10-24",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "HEALTH AND HUMAN SERVICES",
        "authorized_official_telephone_number": "704-982-9171"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "NC",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NC",
            "license": "34D0684540",
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NC",
            "license": "ML0765137",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3404384",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stanly Co Hlth Dept - HealthCheck-EPSDT- FP",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Stanly Co Hlth Dept - HealthCheck-EPSDT- FP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Albemarle, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.