NPIMap

Organization Active NPI

Grace Clinic of Yadkin Valley

  • Adult Medicine Physician
  • Elkin, NC
National Provider Identifier
1356852511
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
GRACE CLINIC OF YADKIN VALLEY
Practice address
948 Johnson Ridge Rd
Elkin, NC 28621-0948
Phone
(336) 835-1467
Fax
(336) 835-1469
NPI assigned
Oct 16, 2017
Last updated
Jul 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Authorized official

Name
Betty White Taylor
Title
Executive Director
Phone
(336) 835-1467

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU
Adult Medicine Physician 207QA0505X NU Primary

Addresses

Primary practice location

948 Johnson Ridge Rd
Elkin, NC 28621-0948

Mailing address

PO Box 978
Elkin, NC 28621-0978
Phone (336) 835-1467

Other practice location 1

110 Dutchman Ct Fl 2
Elkin, NC 28621-2237
Phone (336) 835-1467

Other names 1

  • Tri-County Health Resource Center Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180227002148 NC Part B Supplier - Clinic/Group Practice 4587925961 Receives reassigned benefits from 10 practitioners
Practice locations: Elkin, NC

National Provider Directory

National Provider Directory

Locations

851 Johnson Ridge Rd
Elkin, NC 28621
Phone (336) 835-1467

948 Johnson Ridge Rd
Elkin, NC 28621
Phone (336) 835-1467

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1721/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 11

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": "1508112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1356852511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 978",
            "city": "ELKIN",
            "state": "NC",
            "postal_code": "286210978",
            "telephone_number": "336-835-1467",
            "fax_number": "336-835-1469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "948 JOHNSON RIDGE RD",
            "city": "ELKIN",
            "state": "NC",
            "postal_code": "286210948",
            "telephone_number": "336-835-1467",
            "fax_number": "336-835-1469"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Dutchman Ct Fl 2",
            "address_purpose": "LOCATION",
            "city": "Elkin",
            "state": "NC",
            "postal_code": "286212237",
            "country_code": "US",
            "telephone_number": "336-835-1467",
            "fax_number": "336-835-1469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRACE CLINIC OF YADKIN VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-16",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "WHITE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-835-1467"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri-County Health Resource Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Elkin, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.