NPIMap

Organization Active NPI

Bladen Healthcare, LLC

Doing business as Cape Fear Valley BMA Bladenboro

  • Rural Health Clinic/Center
  • Bladenboro, NC
National Provider Identifier
1417123993
Registry record updated Nov 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H0154 Issued in NC
Legal business name
BLADEN HEALTHCARE, LLC
Doing business as
Cape Fear Valley BMA Bladenboro
Practice address
1106 W Seaboard St
Bladenboro, NC 28320-6985
Phone
(910) 863-3138
Fax
(910) 863-3597
NPI assigned
May 5, 2008
Last updated
Nov 19, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CUMBERLAND COUNTY HEALTH SYSTEM INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 2023

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

Authorized official

Name
Joseph B Fiser
Title
VP Corp Revenue Cycle/Managed Care
Phone
(910) 615-5572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H0154 NC Primary

Addresses

Primary practice location

1106 W Seaboard St
Bladenboro, NC 28320-6985

Mailing address

PO Box 40908
Attn: PFS Provider Enrollment
Fayetteville, NC 28309
Phone (910) 862-6308

Other identifiers 1

IdentifierTypeStateIssuer
34-4601AMedicaidNC

Other names 1

  • Cape Fear Valley BMA Bladenboro Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080617000314 NC Part B Supplier - Clinic/Group Practice 6800967969 Receives reassigned benefits from 173 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elizabethtown, NC; Whiteville, NC; Lumberton, NC; Dublin, NC; Clarkton, NC; Bladenboro, NC
O20131122001500 NC Part A Provider - Rural Health Clinic 6800967969 Practice locations: Bladenboro, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417123993. Details of each certification follow.

Rural health clinic certification: CCN 343446

Legal name
BLADEN HEALTHCARE LLC
Doing business as
CAPE FEAR VALLEY - BLADEN MEDICAL ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 14, 2013
Last certification
Oct 12, 2017
Ownership / control type
2B
Organization structure
LLCProprietary
Incorporated
Mar 20, 2008 in NC
Enrollment address
1106 W Seaboard Street
Bladenboro, NC 28320
Related CCNs
341315

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Part of
Cape Fear Valley Radiology

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Jeannette Council Individual Corporate Director Jun 1, 2008
Cumberland County Hospital System Inc Organization, Fayetteville, NC Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2008
Operational/Managerial Control Jun 1, 2008
Gerald Dean Individual Corporate Director Feb 1, 2009
Heather K Sachs Individual Contracted Managing Employee Feb 9, 2009
Corporate Officer Feb 9, 2009
Michael Nagowski Individual Corporate Director Jun 1, 2008
Joseph Fiser Individual W-2 Managing EmployeeVP Rev Cycle/Managed Care Aug 20, 2021
John T Henley Individual Corporate Director Jun 1, 2008
Divyang R Patel Individual Corporate Director Oct 1, 2008

Owners & managing parties with NPI records 11

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

Facilities with the same owner 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 9

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": "1209945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700352000000",
    "number": "1417123993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40908",
            "address_2": "ATTN: PFS PROVIDER ENROLLMENT",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28309",
            "telephone_number": "910-862-6308",
            "fax_number": "910-862-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 W SEABOARD ST",
            "city": "BLADENBORO",
            "state": "NC",
            "postal_code": "283206985",
            "telephone_number": "910-863-3138",
            "fax_number": "910-863-3597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLADEN HEALTHCARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CUMBERLAND COUNTY HEALTH SYSTEM INC",
        "enumeration_date": "2008-05-05",
        "last_updated": "2023-11-19",
        "certification_date": "2023-11-19",
        "status": "A",
        "authorized_official_last_name": "FISER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "VP CORP REVENUE CYCLE/MANAGED CARE",
        "authorized_official_telephone_number": "910-615-5572"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NC",
            "license": "H0154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34-4601A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cape Fear Valley BMA Bladenboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bladenboro, NC

Sources for this page

Verify at the official NPI Registry.