NPIMap

Organization Active NPI

Rural Health Group, Inc.

Doing business as Rural Health Group at Henderson

  • Federally Qualified Health Center (FQHC)
  • Henderson, NC
National Provider Identifier
1124269022
Registry record updated Sep 10, 2012
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 Henderson
Practice address
100 W Parkview Dr
Henderson, NC 27536-5923
Phone
(252) 536-5791
Fax
(252) 536-5444
NPI assigned
Mar 23, 2009
Last updated
Sep 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2012

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

Authorized official

Name
Mr. Brian O. Harris
Title
Ceo
Phone
(252) 536-5871

Specialties & licenses 1

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

Addresses

Primary practice location

100 W Parkview Dr
Henderson, NC 27536-5923

Mailing address

PO Box 640
Roanoke Rapids, NC 27870-0640
Phone (252) 536-5791

Other identifiers 2

IdentifierTypeStateIssuer
022H1OtherNCBCBS
344023A/CMedicaidNC

Other names 1

  • Rural Health Group at Henderson 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…
O20090831000112 NC Part A Provider - Federally Qualified Health Center (FQHC) 9739090226 Practice locations: Henderson, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124269022. Details of each certification follow.

Federally qualified health center certification: CCN 341946

Legal name
RURAL HEALTH GROUP INC
Doing business as
RURAL HEALTH GROUP AT HENDERSON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 31, 2009
Last certification
Aug 31, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 4, 1985 in NC
Enrollment address
100 W Parkview Dr
Henderson, NC 27536-5923

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
34D1103607Rural Health Group at Henderson100 Parkview Drive West, Henderson, NC 27536Provider-performed microscopyAug 12, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Willie McKinley Greene Individual Other Jul 6, 2009
Chester Bruce Williams Individual Other Sep 24, 2015
Inetha Taylor Individual Corporate OfficerCfo Sep 1, 2012
Ella Green Viverette Individual Other Sep 1, 2012
Cynthia Lynette Brown Individual Other Jul 6, 2009
Yvonne Long Gee Individual Corporate OfficerCeo Jan 27, 2018
Wilhelmena Rae Herritage Mitchell Individual Other Jul 6, 2009
Judy Belch Beasley Individual W-2 Managing EmployeeDirector of Revenue Aug 31, 2009
Jimmie Lewis Sidberry Individual Other Apr 25, 2013
Clyde Anthony Johnston Individual Other Jul 6, 2009
Lutricia Lynch Lewis Individual Other Jul 6, 2009
Rural Health Group Inc Organization, Roanoke Rapids, NC Non-profit Operational/Managerial Control Aug 31, 2009
Nancy Morgan Rodgers Individual Corporate DirectorDirector of Human Resources Jul 6, 2009
Audrey Lee Hardy Individual Other Sep 24, 2015

Owners & managing parties with NPI records 18

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 18

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
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 3

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1237766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347235200000",
    "number": "1124269022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO 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": "100 W PARKVIEW DR",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275365923",
            "telephone_number": "252-536-5791",
            "fax_number": "252-536-5444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-23",
        "last_updated": "2012-09-10",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-536-5871",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "022H1",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344023A/C",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rural Health Group at Henderson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NC

Sources for this page

Verify at the official NPI Registry.