NPIMap

Organization Active NPI

Northern Hospital of Surry County

Doing business as Northern Pediatrics

  • Pediatrics Physician
  • Mount Airy, NC
National Provider Identifier
1386495893
Registry record updated May 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NORTHERN HOSPITAL OF SURRY COUNTY
Doing business as
Northern Pediatrics
Practice address
100 N Pointe Blvd
Mount Airy, NC 27030-2266
Phone
(336) 789-6267
Fax
(336) 786-3796
NPI assigned
Apr 1, 2024
Last updated
May 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2026

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

Authorized official

Name
Rachel Hiatt
Title
Director, Central Billing
Phone
(336) 783-8452

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary
Rural Health Clinic/Center 261QR1300X NU

Addresses

Primary practice location

100 N Pointe Blvd
Mount Airy, NC 27030-2266

Mailing address

PO Box 1267
Mount Airy, NC 27030-1267
Phone (336) 719-7112

Other names 1

  • Northern Pediatrics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241015004760 NC Part A Provider - Rural Health Clinic 0244281749 Practice locations: Mount Airy, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386495893. Details of each certification follow.

Rural health clinic certification: CCN 343481

Legal name
NORTHERN HOSPITAL OF SURRY COUNTY
Doing business as
NORTHERN PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 10, 2024
Last certification
Dec 10, 2024
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
100 N Pointe Blvd
Mount Airy, NC 27030-2266
Related CCNs
340003

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

Other NPIs with the same Medicare PAC ID 6

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

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
34D0894095Northern Hospital District of Surry County100 North Pointe Boulevard, Mt Airy, NC 27030Certificate of waiverJul 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Northern Home Care13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

100 N Pointe Blvd
Mount Airy, NC 27030
Phone (336) 789-6267

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Northern Hospital of Surry County Organization, Mount Airy, NC Corporation, Non-profit Operational/Managerial Control Jan 1, 1966 100%
Derek White Individual Operational/Managerial ControlDirector, Operational Finance Jan 1, 1966 100%
Andrea Hickling Individual Corporate OfficerCfo Aug 1, 2023 100%

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Mountain Valley Hospice & Palliative CareDobson, NC, CCN 341546 Hospice 5% Or Greater Direct Ownership Interest (50%) Oct 1, 2005
Mountain Valley Hospice & Palliative CareGalax, VA, CCN 491580 Hospice 5% Or Greater Direct Ownership Interest (50%) Oct 1, 2005
Northern Obstetrics & GynecologyMount Airy, NC, CCN 343480 Rural health clinic Operational/Managerial Control (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

NPI Registry JSON

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779840000000",
    "number": "1386495893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1267",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270301267",
            "telephone_number": "336-719-7112",
            "fax_number": "336-786-3752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N POINTE BLVD",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270302266",
            "telephone_number": "336-789-6267",
            "fax_number": "336-786-3796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN HOSPITAL OF SURRY COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-01",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A",
        "authorized_official_last_name": "HIATT",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "DIRECTOR, CENTRAL BILLING",
        "authorized_official_telephone_number": "336-783-8452"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northern Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Airy, NC

Sources for this page

Verify at the official NPI Registry.