NPIMap

Organization Active NPI

Granville Health System

Doing business as South Granville Primary Care

  • Rural Health Clinic/Center
  • Creedmoor, NC
National Provider Identifier
1265430854
Registry record updated Jul 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRANVILLE HEALTH SYSTEM
Doing business as
South Granville Primary Care
Practice address
1614 NC Highway 56
Creedmoor, NC 27522-8297
Phone
(919) 575-6103
Fax
(919) 575-6817
NPI assigned
Jul 8, 2005
Last updated
Jul 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2026

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

Authorized official

Name
Melanie Hobgood
Title
Acting Ceo
Phone
(919) 690-3445

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1614 NC Highway 56
Creedmoor, NC 27522-8297

Mailing address

PO Box 986
Oxford, NC 27565-0986
Phone (919) 575-6103

Other identifiers 3

IdentifierTypeStateIssuer
344645AMedicaidNC
344645CMedicaidNC
02578OtherNCBCBSNC

Other names 1

  • South Granville Primary Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040312001033 NC Part B Supplier - Clinic/Group Practice 1052223757 Receives reassigned benefits from 125 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oxford, NC; Creedmoor, NC
O20090427000061 NC Part A Provider - Rural Health Clinic 1052223757 Practice locations: Creedmoor, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265430854. Details of each certification follow.

Rural health clinic certification: CCN 343436

Legal name
GRANVILLE HEALTH SYSTEM
Doing business as
SOUTH GRANVILLE PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 9, 2009
Last certification
Jan 19, 2021
Ownership / control type
1B
Organization structure
OtherNon-profit
Enrollment address
1614 Hwy 56
Creedmoor, NC 27522-8297
Related CCNs
340127

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 7

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

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
34D0894096South Granville Primary Care1614 Hwy 56, Creedmoor, NC 27522Provider-performed microscopyNov 6, 2026

National Provider Directory

National Provider Directory

Locations

317 Central Ave
Butner, NC 27509
Phone (919) 575-6103

1614 NC Highway 56
Creedmoor, NC 27522
Phone (919) 528-7171

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
Granville Health System Organization, Creedmoor, NC 5% Or Greater Direct Ownership Interest Jul 1, 2008
Operational/Managerial Control Jul 1, 2008
Robert Wheeler Individual OtherTrustee/Board Member Jan 1, 2022
James Lumpkins Individual Corporate DirectorBoard Member Jan 1, 2021
David Smith Individual OtherBoard of Trustees Jan 1, 2018
Dawn Marie Scott Omokunde Individual OtherBoard of Trustees Jan 1, 2018
Annmarie Holtzman-Wheeler Individual Corporate OfficerCno, Board Member Oct 1, 2019
Corporate DirectorCno, Board Member Oct 1, 2019
Jamie Purvis Individual Corporate Director Feb 1, 2023
Joseph C Zola Individual OtherTrustee/Chief of Staff Jan 1, 2022
Tony Cozart Individual OtherTrustee Jul 1, 2008
Adam W McConnell Individual Corporate OfficerCfo Oct 1, 2018
Corporate DirectorCfo Oct 1, 2018
W-2 Managing EmployeeCfo Oct 1, 2018
Zelodis Jay Individual OtherTrustee Jan 1, 2005
Timothy Karan Individual OtherTrustee Jan 1, 2012
Jim Cyril Blaine Individual Corporate DirectorBoard Member Jan 1, 2021
Shane M Hodge Individual OtherTrustee Jan 1, 2023
James Wiley Gooch Individual Corporate DirectorBoard Member Jan 1, 2021

Owners & managing parties with NPI records 9

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
Granville Internal Medicine and GeriatricsOxford, NC, CCN 343437 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 2009
Aug 1, 2009

Owned or controlled facilities with NPI records 1

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

  • Granville Health System

    dba Granville Internal Medicine & Geriatrics

    • Rural Health Clinic/Center
    • Oxford, NC
    • NPI 1811999055

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783468800000",
    "number": "1265430854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 986",
            "city": "OXFORD",
            "state": "NC",
            "postal_code": "275650986",
            "telephone_number": "919-575-6103",
            "fax_number": "919-575-6817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 NC HIGHWAY 56",
            "city": "CREEDMOOR",
            "state": "NC",
            "postal_code": "275228297",
            "telephone_number": "919-575-6103",
            "fax_number": "919-575-6817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANVILLE HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A",
        "authorized_official_last_name": "HOBGOOD",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "ACTING CEO",
        "authorized_official_telephone_number": "919-690-3445"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344645A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344645C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "02578",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Granville Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Granville Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Creedmoor, NC

Sources for this page

Verify at the official NPI Registry.