NPIMap

Organization Active NPI

Carolina Family Health Centers, Inc

Doing business as Wilson Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Wilson, NC
National Provider Identifier
1184792103
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAROLINA FAMILY HEALTH CENTERS, INC
Doing business as
Wilson Community Health Center
Practice address
303 Green St E
Wilson, NC 27893-4105
Phone
(252) 243-9800
Fax
(252) 243-9888
NPI assigned
Nov 30, 2006
Last updated
Oct 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

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

Authorized official

Name
Mrs. Laura OwensNPI 1750410809
Title
Ceo
Phone
(252) 293-0013

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

303 Green St E
Wilson, NC 27893-4105

Mailing address

303 Green St E
Wilson, NC 27893-4105
Phone (252) 293-0013

Other names 1

  • WILSON COMMUNITY HEALTH CENTER Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050516000751 NC Part A Provider - Federally Qualified Health Center (FQHC) 6800841107 Practice locations: Wilson, NC
O20050915000563 NC Part B Supplier - Clinic/Group Practice 6800841107 Receives reassigned benefits from 32 practitioners
4 other NPIs on this enrollment
Practice locations: Elm City, NC; Tarboro, NC; Wilson, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184792103. Details of each certification follow.

Federally qualified health center certification: CCN 341859

Legal name
CAROLINA FAMILY HEALTH CENTERS, INC.
Doing business as
WILSON COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 1, 2000
Last certification
Mar 1, 2000
Ownership / control type
For profit – individual
Organization structure
CorporationNon-profit
Incorporated
Jun 8, 1993 in NC
Enrollment address
303 Green St E
Wilson, NC 27893-4105

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Evelyn Pruden Individual Corporate Director Aug 16, 2010
Gloria Vazquez Individual 5% Or Greater Direct Ownership Interest Aug 16, 2010
Renee Rashid Individual Corporate DirectorBoard Member Oct 1, 2011
Charles Taylor Individual Corporate DirectorBoard Member Dec 1, 2013
Phillip Byrum Individual Corporate DirectorBoard Member Aug 1, 2015
Laura Owens Individual Corporate OfficerChief Executive Officer Jul 1, 2018
Jerome Garner Individual Corporate Director Aug 16, 2010
Elisabed Serrano Individual Corporate DirectorBoard Member Nov 1, 2013
Joanne Lucas Individual Corporate Director Oct 25, 2010
Paula McMillian Individual W-2 Managing Employee Aug 1, 2010
Michele Cherry Individual Corporate DirectorBoard Member Apr 1, 2019

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698278400000",
    "number": "1184792103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 GREEN ST E",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278934105",
            "telephone_number": "252-293-0013",
            "fax_number": "252-243-2576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 GREEN ST E",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278934105",
            "telephone_number": "252-243-9800",
            "fax_number": "252-243-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA FAMILY HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-293-0013",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILSON COMMUNITY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WILSON COMMUNITY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilson, NC

Sources for this page

Verify at the official NPI Registry.