NPIMap

Organization Active NPI

Metropolitan Community Health Services, Inc

Doing business as Agape Community Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Washington, NC
National Provider Identifier
1366488280
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
METROPOLITAN COMMUNITY HEALTH SERVICES, INC
Doing business as
Agape Community Health Clinic
Practice address
120 W Martin Luther King Jr Dr
Washington, NC 27889-4906
Phone
(252) 940-0602
Fax
(252) 940-0605
NPI assigned
Jun 20, 2006
Last updated
Apr 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

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

Authorized official

Name
Mr. Laurence J Doby
Title
Office Manager
Phone
(252) 644-7003

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Federal Public Health Clinic/Center 261QP0904X

Addresses

Primary practice location

120 W Martin Luther King Jr Dr
Washington, NC 27889-4906

Mailing address

PO Box 1886
Washington, NC 27889-1886
Phone (252) 940-0602

Other identifiers 3

IdentifierTypeStateIssuer
0179GOtherNCBCBS
344591AMedicaidNC
890179GOtherNCNORTH CAROLINA ACCESS

Other names 1

  • AGAPE COMMUNITY HEALTH CLINIC Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030717000024 NC Part A Provider - Federally Qualified Health Center (FQHC) 9931010881 Practice locations: Washington, NC
O20040630000822 NC Part B Supplier - Clinic/Group Practice 9931010881 Receives reassigned benefits from 46 practitioners
4 other NPIs on this enrollment
Practice locations: Williamston, NC; Washington, NC; Plymouth, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366488280. Details of each certification follow.

Federally qualified health center certification: CCN 341871

Legal name
METROPOLITAN COMMUNITY HEALTH SERVICES INC
Doing business as
AGAPE COMMUNITY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 8, 2003
Last certification
Sep 8, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 30, 1999 in NC
Enrollment address
120W Martin Luther King Jr Dr
Washington, NC 27889-4906

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Ownership & related parties

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.

NameRoleSinceShare
Fashikie Smith Individual Corporate Director Sep 3, 2010
Laurence J Doby Individual Corporate DirectorExecutive Director Jan 1, 2019
Operational/Managerial ControlOperations Manager Jun 1, 2013 100%
Azucena Warren Individual Corporate Director Sep 3, 2010
Dorothy Gibbs Individual Corporate Director Sep 3, 2010
Michael L McDuffie Individual 5% Or Greater Direct Ownership Interest Jan 1, 2015
Corporate Director Jan 1, 2015
W-2 Managing Employee Jan 1, 2019
Phedora Johnson Individual Corporate Director Sep 3, 2010
Patricia Reddick Individual Corporate Director Sep 3, 2010

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Agape Community Health CenterWilliamston, NC, CCN 341021 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 14, 2013
Agape Health Services- PlymouthPlymouth, NC, CCN 341174 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2022
Agape Health Services Mobile UnitWashington, NC, CCN 341179 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 1999
Agape Health Services - Carolina AvenueWashington, NC, CCN B61073 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 16, 2025

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 50

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 50

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617667200000",
    "number": "1366488280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1886",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278891886",
            "telephone_number": "252-940-0602",
            "fax_number": "252-940-0605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W MARTIN LUTHER KING JR DR",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278894906",
            "telephone_number": "252-940-0602",
            "fax_number": "252-940-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METROPOLITAN COMMUNITY HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A",
        "authorized_official_last_name": "DOBY",
        "authorized_official_first_name": "LAURENCE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "252-644-7003",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP0904X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, Federal",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0179G",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344591A",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA ACCESS",
            "identifier": "890179G",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AGAPE COMMUNITY HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, NC

Sources for this page

Verify at the official NPI Registry.