Lifebrite Hospital Group of Stokes, LLC
Organization Active NPI Rural Health Clinic/Center · Pine Hall, NC
NPI 1346775285 · NPPES record last updated Mar 27, 2019
Key facts
- NPI
- 1346775285
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- H0165 (NC)
- Legal business name
- LIFEBRITE HOSPITAL GROUP OF STOKES, LLC
- Practice address
- 3853 US 311 Hwy N
Pine Hall, NC 27042-8184 - Phone
- (336) 593-5311
- Fax
- (336) 593-5350
- NPI assigned
- Apr 28, 2017
- Organization subpart
- No
Authorized official
- Name
- Pamela Priddy Tillman
- Title
- Administrator
- Phone
- (336) 593-5314
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 5
Related certifications (CCN) 1
Facilities with the same owner 4
Practitioners 29
-
David Roberts Sanders, PA-C
-
Benjamin Samson Schmidt, M.D.
-
Franco Abad, PA
-
Roshen Thomas Edathil, CRNA
-
William R Fox, M.D.
-
Nicole Lynn Garner, FNP
-
Mark Hampton Harris, PA-C
-
Daniel Smith, CRNA
-
Molly Drum Stewart, CRNA
-
Terri L Thompson, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Rural health clinic certification: CCN 343470
- Legal name
- LIFEBRITE HOSPITAL GROUP OF STOKES LLC
- Doing business as
- LIFEBRITE FAMILY MEDICAL & URGENT CARE OF PINE HALL
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 14, 2019
- Last certification
- Feb 11, 2025
- Ownership / control type
- 1B
- Organization structure
- LLC · Proprietary
- Incorporated
- Oct 12, 2016 in GA
- Enrollment address
- 3853 US 311 Hwy N
Pine Hall, NC 27042-8184 - Related CCNs
- 341317
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Lifebrite Hospital Group LLC |
5% Or Greater Direct Ownership Interest | Jan 31, 2017 | 100% |
| Christian Fletcher |
5% Or Greater Indirect Ownership Interest |
Oct 12, 2016 | 100% |
| Pamela Tillman |
W-2 Managing Employee |
Jan 31, 2017 | |
| Amber D Fletcher |
Operational/Managerial Control |
Jan 31, 2017 | |
| Lifebrite Laboratories, LLC |
5% Or Greater Indirect Ownership Interest | Jan 31, 2017 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170220001211 | NC | Part B Supplier - Clinic/Group Practice | 8921380759 |
Receives reassigned benefits from 29 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: King, NC; Pine Hall, NC; Danbury, NC |
| O20181113001550 | NC | Part a Provider - Rural Health Clinic | 8921380759 | Practice locations: Pine Hall, NC |
National Provider Directory
Locations
1570 NC 8 and 89 Hwy N
Danbury, NC 27016
Phone (336) 593-2831
3853 US 311 Hwy N
Pine Hall, NC 27042
Phone (336) 427-3076
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | H0165 | NC | Yes |
| Urgent Care Clinic/Center | 261QU0200X | H0165 | NC |
Addresses
Primary practice location
3853 US 311 Hwy N
Pine Hall, NC 27042-8184
Mailing address
3853 US 311 Hwy N
Pine Hall, NC 27042-8184
Phone (336) 427-3076
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H0165 | Other | NC | STATE LICENSURE |
Other names
- LifeBrite Family Medical & Urgent Care of Pine Hall
Other providers in Pine Hall, NC
- Kirkland McKinney Dickey
- Novant Health Stokes Medical Center, LLC
- Novant Health Stokes Medical Center, LLC
- James Bailey Sanford
All providers in Pine Hall, NC · Rural Health Clinic/Center in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.