NPIMap

Organization Active NPI

Opportunities Industrialization Center, Inc.

Doing business as Oic Family Medical Center Guardian Court

  • Federally Qualified Health Center (FQHC)
  • Rocky Mount, NC
National Provider Identifier
1396103305
Registry record updated Dec 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OPPORTUNITIES INDUSTRIALIZATION CENTER, INC.
Doing business as
Oic Family Medical Center Guardian Court
Practice address
90 Guardian CT
Rocky Mount, NC 27804-3017
Phone
(252) 212-3350
Fax
(252) 212-0322
NPI assigned
Feb 4, 2016
Last updated
Dec 7, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
OPPORTUNITIES INDUSTRIALIZATION CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 7, 2021

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

Authorized official

Name
Shirley Monk-Jones
Title
Billing Manager
Phone
(252) 212-3486

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NC Primary

Addresses

Primary practice location

90 Guardian CT
Rocky Mount, NC 27804-3017

Mailing address

PO Box 2723
Rocky Mount, NC 27802-2723
Phone (252) 212-3350

Other practice location 1

801 Williford St
Rocky Mount, NC 27803-3825
Phone (252) 212-3350

Other practice location 2

1400 Bethlehem Rd
Rocky Mount, NC 27803-2203
Phone (252) 212-3350

Other names 1

  • OIC FAMILY MEDICAL CENTER GUARDIAN COURT Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160720000567 NC Part A Provider - Federally Qualified Health Center (FQHC) 3173563590 1 other NPI on this enrollment
Practice locations: Rocky Mount, NC
O20161104000262 NC Part B Supplier - Clinic/Group Practice 3173563590 Receives reassigned benefits from 48 practitioners
1 other NPI on this enrollment
Practice locations: Rocky Mount, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396103305. Details of each certification follow.

Federally qualified health center certification: CCN 341045

Legal name
OPPORTUNITIES INDUSTRIALIZATION CENTER, INC
Doing business as
OIC FAMILY MEDICAL CENTER GUARDIAN COURT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 20, 2016
Last certification
Jul 20, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 19, 1969 in NC
Enrollment address
90 Guardian CT
Rocky Mount, NC 27804-3017

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

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

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
34D2112906Oic Family Medical Center Guardian Court90 Guardian Court, Rocky Mount, NC 27804Certificate of waiverMay 10, 2028

National Provider Directory

National Provider Directory
Part of
Opportunities Industrialization Center Inc

Locations

1400 Bethlehem Rd
Rocky Mount, NC 27803
Phone (252) 212-3350

90 Guardian Ct
Rocky Mount, NC 27804
Phone (252) 212-3350

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Brenda F Cutchin Individual Corporate DirectorBoard Member Jul 1, 2013
Shirley Monk-Jones Individual W-2 Managing EmployeeDelegated Official Dec 1, 2011
Chayan Tiwari Individual Operational/Managerial Control Apr 1, 2023
Reuben Blackwell Individual Corporate OfficerCeo Sep 6, 2007
Opportunities Industrialization Center, Inc Organization, Rocky Mount, NC Non-profit Operational/Managerial Control Jan 14, 2005
Sherri Bryant Individual Operational/Managerial Control Apr 1, 2023
Samuel Dickens Individual Corporate OfficerCoo Jan 1, 2009
Mary Johnson Mann Individual Corporate Director Apr 1, 2005
Donna Johnson Individual Corporate DirectorTreasurer Apr 1, 2005
Hubert D Pope Individual Corporate DirectorBoard Member Jan 1, 2011
Andre Knight Individual Corporate DirectorBoard Member Jan 1, 2000
Doris K Thorne Individual Corporate DirectorBoard Member Jan 1, 2011
Evelyn Wilson Individual Corporate DirectorSecretary Apr 1, 2005
Leonard Tillery Individual Corporate DirectorBoard Member Jul 1, 2013
Brian Ellerby Individual Corporate OfficerIntegrated Health Services Director Jun 1, 2015

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Oic Family Medical Center at Happy HillRocky Mount, NC, CCN 341023 Federally qualified health center Operational/Managerial Control Jan 14, 2005
Oic Family Medical Center at Community Health PlazaRocky Mount, NC, CCN 341059 Federally qualified health center Operational/Managerial Control Jan 14, 2005
Oic Specialty Care CenterRocky Mount, NC, CCN 341096 Federally qualified health center Operational/Managerial Control Mar 3, 2008
Oic Sunset AvenueRocky Mount, NC, CCN B61010 Federally qualified health center Operational/Managerial Control Jun 28, 2022

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 4

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

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": "1454544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1396103305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2723",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278022723",
            "telephone_number": "252-212-3350",
            "fax_number": "252-212-0322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 GUARDIAN CT",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278043017",
            "telephone_number": "252-212-3350",
            "fax_number": "252-212-0322"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Williford St",
            "address_purpose": "LOCATION",
            "city": "Rocky Mount",
            "state": "NC",
            "postal_code": "278033825",
            "country_code": "US",
            "telephone_number": "252-212-3350",
            "fax_number": "252-212-0322",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1400 Bethlehem Rd",
            "address_purpose": "LOCATION",
            "city": "Rocky Mount",
            "state": "NC",
            "postal_code": "278032203",
            "country_code": "US",
            "telephone_number": "252-212-3350",
            "fax_number": "252-212-0322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPPORTUNITIES INDUSTRIALIZATION CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPPORTUNITIES INDUSTRIALIZATION CENTER, INC",
        "enumeration_date": "2016-02-04",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A",
        "authorized_official_last_name": "MONK-JONES",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "252-212-3486"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OIC FAMILY MEDICAL CENTER GUARDIAN COURT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OIC FAMILY MEDICAL CENTER GUARDIAN COURT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rocky Mount, NC

Sources for this page

Verify at the official NPI Registry.