Access Medical Clinic North Carolina PLLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

ACCESS MEDICAL CLINIC NORTH CAROLINA PLLC

Practice address

18901 Ida Mill Rd
Laurel Hill, NC 28351-8326

Phone

(870) 856-1202

Fax

(870) 856-2107

NPI assigned

Dec 22, 2021

Last updated

Apr 11, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bradley Ray Bibb, MDNPI 1700824307

Title

Owner/Ceo

Phone

(870) 856-1202

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205596962. Details of each certification follow.

• CCN 348971 Rural health clinic · Active · Details

Rural health clinic certification: CCN 348971

Legal name

ACCESS MEDICAL CLINIC NORTH CAROLINA PLLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jul 21, 2022

Last certification

Jul 21, 2022

Ownership / control type

1A

Organization structure

LLCProprietary

Incorporated

Oct 7, 2021 in AR

Enrollment address

18901 Ida Mill Rd
Laurel Hill, NC 28351-8326

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25499/brand/1/csg/1/fhir/r4

All disclosed owners & managing parties 7

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

Owners & managing parties with NPI records 2

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

• Randi L Davis, APRN

  • Family Nurse Practitioner
  • Bay, AR
  • NPI 1740622497

  Corporate Director, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership
• Mark S Hahn, DO

  • Family Medicine Physician
  • Caraway, AR
  • NPI 1609895911

  5% Or Greater Direct Ownership Interest, Corporate Director

  CMS ownership

Practitioners 9

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.

• Bradley Ray Bibb, MD

  • Family Medicine Physician
  • Ash Flat, AR
  • NPI 1700824307

  NC

  Medicare reassignment NPD Authorized official
• Terri N Moody, APN

  • Family Nurse Practitioner
  • West Memphis, AR
  • NPI 1750577698

  NC

  Medicare reassignment Care Compare group NPD
• Kondie Lee Lykins, PA-C

  • Physician Assistant
  • Pinehurst, NC
  • NPI 1437515335
  Medicare reassignment Care Compare group
• Jennifer Renae Bullard, NP-C

  • Family Nurse Practitioner
  • Clinton, TN
  • NPI 1659912731

  NC

  Medicare reassignment NPD
• Mark S Hahn, DO

  • Family Medicine Physician
  • Caraway, AR
  • NPI 1609895911

  NC

  Medicare reassignment NPD
• Dixie Lee Bhiro, PA

  • Physician Assistant
  • Laurel Hill, NC
  • NPI 1437157997
  NPD (past)
• Thakurdeo Michael Bhiro, PA

  • Physician Assistant
  • Laurel Hill, NC
  • NPI 1730187295
  NPD (past)
• Donald Alwin Nisbett, MD

  • Family Medicine Physician
  • Laurinburg, NC
  • NPI 1487616223
  NPD (past)
• Candice Cartwright

  • Nurse Practitioner
  • Lafayette, LA
  • NPI 1861872699
  NPD (past)

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

{
    "created_epoch": "1640131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681171200000",
    "number": "1205596962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412 STE A",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002",
            "telephone_number": "870-856-1202",
            "fax_number": "870-856-2107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18901 IDA MILL RD",
            "city": "LAUREL HILL",
            "state": "NC",
            "postal_code": "283518326",
            "telephone_number": "870-856-1202",
            "fax_number": "870-856-2107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS MEDICAL CLINIC NORTH CAROLINA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-22",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "BIBB",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "870-856-1202",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Assurance Care Transportation LLC
• Dixie Lee Bhiro, PA
• Thakurdeo Michael Bhiro, PA
• Miriya Mechae Bryant, MSW, LCSWA
• Laurel Hill Family Medicine PA

• Rural Health Clinic/Center in Laurel Hill, NC
• Providers in Laurel Hill, NC by specialty
• Rural Health Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.