NPIMap

Organization Active NPI

Henderson County Hospital Corporation

Doing business as Pardee BlueMD-3334 Boylston Highway, Suite 20

  • Federally Qualified Health Center (FQHC)
  • Mills River, NC
National Provider Identifier
1124757836
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HENDERSON COUNTY HOSPITAL CORPORATION
Doing business as
Pardee BlueMD-3334 Boylston Highway, Suite 20
Practice address
3334 Boylston Highway
Suite 20
Mills River, NC 28759
Phone
(828) 694-8150
Fax
(828) 694-8151
NPI assigned
Jun 8, 2022
Last updated
May 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Authorized official

Name
Mr. Michael Lynn Sunday Jr.
Title
VP, Chief Financial Officer
Phone
(828) 696-1175

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Multi-Specialty Clinic/Center 261QM1300X NU

Addresses

Primary practice location

3334 Boylston Highway
Suite 20
Mills River, NC 28759

Mailing address

5221 Paramount Pkwy Ste 440
Morrisville, NC 27560-5491
Phone (984) 974-1190

Other names 1

  • Pardee BlueMD-3334 Boylston Highway, Suite 20 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20221018003658 NC Part A Provider - Federally Qualified Health Center (FQHC) 8123938115 Practice locations: Mills River, NC
O20230125003479 NC Part B Supplier - Clinic/Group Practice 8123938115 Receives reassigned benefits from 5 practitioners
Practice locations: Mills River, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124757836. Details of each certification follow.

Federally qualified health center certification: CCN 341818

Legal name
HENDERSON COUNTY HOSPITAL CORPORATION
Doing business as
PARDEE BLUEMD-3334 BOYLSTON HIGHWAY, SUITE 20
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 19, 2022
Last certification
Oct 19, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 24, 1998 in NC
Enrollment address
3334 Boylston Hwy
Ste 20
Mills River, NC 28759-4103

Other NPIs with the same Medicare PAC ID 19

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

View all 19

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
34D2175330Pardee Bluemd3334 Boylston Highway, Suite 20, Mills River, NC 28759Certificate of waiverNov 18, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • County of Henderson

    dba Henderson County Department of Public Health

    • Public Health or Welfare Agency
    • Hendersonville, NC
    • NPI 1902957954

    Member Of

    NPD member

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Andrea Vivian Bolanos Padilla Individual Corporate DirectorBoard of Director Nov 1, 2021
Erik a Emaus Individual Corporate DirectorBoard Member Jul 1, 2025
John Gould Individual Corporate DirectorBoard of Director Nov 1, 2021
Hyatt James Chandler Individual Corporate DirectorBoard of Director Nov 1, 2021
Richard W Hudspeth Individual Corporate DirectorBoard of Director Oct 20, 2022
Marilyn Allison Gordon Individual Corporate DirectorBoard of Director Oct 1, 2022
James Stevens Brissie Individual Corporate DirectorBoard of Director Nov 1, 2022
County of Henderson Organization, Hendersonville, NC 5% Or Greater Direct Ownership Interest Apr 24, 1998 100%
University of North Carolina Health Care System Organization, Morrisville, NC Corporation Operational/Managerial Control Jun 22, 2011 100%
Hubbard Thomas Thompson Individual Corporate DirectorBoard of Director Nov 1, 2021
Suzanne Johnna Reed Individual Corporate OfficerChief Executive Officer May 1, 2022
Laura Ward Individual W-2 Managing EmployeeDirector of Practice Operations May 1, 2022
Maurean Yates Burritt Adams Individual Corporate DirectorBoard Member Jul 1, 2025
Maurice Lamont Jones Individual Corporate DirectorBoard Member Jul 1, 2025
Michael Lynn Sunday Individual Corporate OfficerChief Financial Officer, Vice Pres May 1, 2022
Orr Tamela Albrecht Individual Corporate DirectorBoard of Director Mar 1, 2024
Gregory S McCarty Individual Corporate OfficerChief Medical Officer May 1, 2022
Carla Jayne Icenhower Individual Corporate DirectorBoard Member Jul 1, 2025

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Pardee Home CareFlat Rock, NC, CCN 347028 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 24, 1998
Apr 24, 1998

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 44

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

View all 44

Practitioners & affiliated clinicians

Practitioners 5

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": "1654646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1124757836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5221 PARAMOUNT PKWY STE 440",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275605491",
            "telephone_number": "984-974-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3334 BOYLSTON HIGHWAY",
            "address_2": "SUITE 20",
            "city": "MILLS RIVER",
            "state": "NC",
            "postal_code": "28759",
            "telephone_number": "828-694-8150",
            "fax_number": "828-694-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON COUNTY HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-08",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "SUNDAY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "VP, CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "828-696-1175",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pardee BlueMD-3334 Boylston Highway, Suite 20",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pardee BlueMD-3334 Boylston Highway, Suite 20",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mills River, NC

Sources for this page

Verify at the official NPI Registry.