NPIMap

Organization Active NPI

Rural Health Group, Inc.

Doing business as Rural Health Group at Roanoke Rapids/Pediatrics

  • Federally Qualified Health Center (FQHC)
  • Roanoke Rapids, NC
National Provider Identifier
1255683157
Registry record updated Oct 3, 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 Roanoke Rapids/Pediatrics
Practice address
2064 NC Highway 125
Roanoke Rapids, NC 27870-9436
Phone
(252) 536-5440
Fax
(252) 536-5444
NPI assigned
Oct 3, 2012
Last updated
Oct 3, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 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) 536-5440

Specialties & licenses 1

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

Addresses

Primary practice location

2064 NC Highway 125
Roanoke Rapids, NC 27870-9436

Mailing address

PO Box 640
Roanoke Rapids, NC 27870-0640
Phone (252) 536-5440

Other names 1

  • Rural Health Group at Roanoke Rapids/Pediatrics 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…
O20121119000475 NC Part A Provider - Federally Qualified Health Center (FQHC) 9739090226 2 other NPIs on this enrollment
Practice locations: Roanoke Rapids, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255683157. Details of each certification follow.

Federally qualified health center certification: CCN 341004

Legal name
RURAL HEALTH GROUP INC
Doing business as
RURAL HEALTH GROUP AT ROANOKE RAPIDS/PEDIATRICS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 20, 2012
Last certification
Dec 20, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 4, 1985 in NC
Enrollment address
2064 NC Highway 125
Roanoke Rapids, NC 27870-9436

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

National Provider Directory

National Provider Directory
Tax ID family
Rural Health Group Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

250 Smith Church Rd
Ste Rhg
Roanoke Rapids, NC 27870
Phone (252) 308-9699

Ownership & related parties

All disclosed owners & managing parties 15

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 Corporate DirectorBoard Member Nov 1, 2012
Chester Bruce Williams Individual Corporate DirectorBoard Member Mar 8, 2016
Gary Lavern Wingfield Individual Corporate DirectorBoard Member Aug 18, 2019
Krystian Gayle Latham Individual Corporate DirectorBoard Member Feb 24, 2022
Ella Green Viverette Individual Corporate DirectorBoard Member Nov 1, 2012
Jimille Evans Mills Individual Corporate DirectorBoard Member Jan 28, 2021
Cynthia Lynette Brown Individual Corporate DirectorBoard Member Nov 1, 2012
Yvonne Long Gee Individual Corporate OfficerCeo Jan 27, 2018
Wilhelmena Rae Herritage Mitchell Individual Corporate DirectorBoard Member Nov 1, 2012
Judy Belch Beasley Individual W-2 Managing EmployeeDirector of Revenue Nov 1, 2012
Sara Myrick Council Individual Corporate DirectorBoard Member Mar 17, 2019
Jimmie Lewis Sidberry Individual Corporate DirectorBoard Member Dec 20, 2013
Clyde Anthony Johnston Individual Corporate DirectorBoard Member Nov 1, 2012
Lutricia Lynch Lewis Individual Corporate DirectorBoard Member Nov 1, 2012
Audrey Lee Hardy Individual Corporate DirectorBoard Member Mar 8, 2016

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Rural Health Group at HendersonHenderson, NC, CCN 341946 Federally qualified health center Operational/Managerial Control Aug 31, 2009
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 4

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1349222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349222400000",
    "number": "1255683157",
    "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": "252-536-5440",
            "fax_number": "252-536-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2064 NC HIGHWAY 125",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278709436",
            "telephone_number": "252-536-5440",
            "fax_number": "252-536-5444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-03",
        "last_updated": "2012-10-03",
        "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": "252-536-5440",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rural Health Group at Roanoke Rapids/Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke Rapids, NC

Sources for this page

Verify at the official NPI Registry.