NPIMap

Organization Active NPI

Tri County Community Health Council Inc

  • Federally Qualified Health Center (FQHC)
  • Benson, NC
National Provider Identifier
1376899252
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Practice address
70 Crape Myrtle Dr Ste 104
Benson, NC 27504-8034
Phone
(877) 935-5255
Fax
(910) 236-2118
NPI assigned
Jul 30, 2012
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
William C Ellison
Title
Revenue Cycle Manager
Phone
(910) 567-7065

Other NPIs on the same Medicare enrollment 19

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

View all 19

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 29

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040702000780 NC Part B Supplier - Clinic/Group Practice 2163409558 Receives reassigned benefits from 52 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Willard, NC; Tar Heel, NC; Smithfield, NC; Shallotte, NC; Dunn, NC; Salemburg, NC; Ocean Isle Beach, NC; Harrells, NC…
O20140619001689 NC Part A Provider - Federally Qualified Health Center (FQHC) 2163409558 Practice locations: Benson, NC

Federally qualified health center certification: CCN 341016

Legal name
TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Doing business as
COMMWELL HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 19, 2014
Last certification
Jun 19, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 21, 1977 in NC
Enrollment address
70 Crape Myrtle Drive
Suite 104
Benson, NC 27504-8034

All disclosed owners & managing parties 15

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Nancy J Blackman Individual Corporate DirectorBoard of Directors Nov 17, 2005
Phillip E Mills Individual Corporate DirectorBoard of Directors Jul 22, 2004
Vanessa a Burgess Individual Corporate DirectorBoard of Directors Jul 26, 1991
Raymond Lindsey Individual Corporate DirectorBoard of Directors Oct 14, 2010
Kenneth a Cabral Individual Corporate DirectorBoard of Directors Apr 16, 2015
Nathan J Tilghman Individual Corporate DirectorBoard of Directors Jun 20, 1994
Mary Crumpler Individual Corporate DirectorBoard of Directors Mar 17, 2015
Silvia a. Cendejas Individual Corporate DirectorBoard of Directors Dec 15, 2011
Gary Herring Individual Corporate DirectorBoard of Directors Mar 17, 2016
Spencer McAlpine Individual Corporate DirectorBoard Or Directors Aug 29, 2013
William Taylor Individual Corporate DirectorBoard of Directors May 18, 2017
Jose Garcia Individual Corporate DirectorBoard Member Aug 1, 2019
Pamela Tripp Individual Corporate OfficerPresident/Ceo Sep 21, 2009
Corporate DirectorPresident/Ceo Sep 21, 2009
W-2 Managing EmployeePresident/Ceo Sep 21, 2009 100%
Mary E Blaizes Individual Corporate DirectorBoard of Directors Jul 17, 1997
William C Ellison Individual Corporate OfficerReveneu Cycle Manager Mar 1, 2022

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

70 Crape Myrtle Dr Ste 104
Benson, NC 27504-8034

Mailing address

PO Box 340
Four Oaks, NC 27524-0340
Phone (910) 567-6194

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
5920729MedicaidNC
341016OtherNCMEDICARE OSCAR

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 27, 2024.

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711497600000",
    "number": "1376899252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 340",
            "city": "FOUR OAKS",
            "state": "NC",
            "postal_code": "275240340",
            "telephone_number": "910-567-6194",
            "fax_number": "910-567-4389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 CRAPE MYRTLE DR STE 104",
            "city": "BENSON",
            "state": "NC",
            "postal_code": "275048034",
            "telephone_number": "877-935-5255",
            "fax_number": "910-236-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI COUNTY COMMUNITY HEALTH COUNCIL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-30",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A",
        "authorized_official_last_name": "ELLISON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "910-567-7065"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5920729",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE OSCAR",
            "identifier": "341016",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benson, NC

Sources for this page

Verify at the official NPI Registry.