NPIMap

Organization Active NPI

Tri County Community Health Council Inc

  • Federally Qualified Health Center (FQHC)
  • Four Oaks, NC
National Provider Identifier
1427087709
Registry record updated Jun 4, 2026
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
6114 US Highway 301 S
Four Oaks, NC 27524-7417
Phone
(877) 935-5255
Fax
(910) 236-2118
NPI assigned
Jun 30, 2006
Last updated
Jun 4, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2026

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

Authorized official

Name
Mr. William C Ellison
Title
Revenue Cycle Manager
Phone
(910) 567-7065

Specialties & licenses 1

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

Addresses

Primary practice location

6114 US Highway 301 S
Four Oaks, NC 27524-7417

Mailing address

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

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
Practice locations: Willard, NC; Tar Heel, NC; Smithfield, NC; Shallotte, NC; Dunn, NC; Salemburg, NC; Ocean Isle Beach, NC; Harrells, NC…
O20091119000515 NC Part A Provider - Federally Qualified Health Center (FQHC) 2163409558 Practice locations: Four Oaks, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427087709. Details of each certification follow.

Federally qualified health center certification: CCN 341835

Legal name
TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Doing business as
COMMWELL HEALTH OF NEWTON GROVE/SPIVEY'S CORNER
Certification status
Terminated Voluntary: merger or closure, Feb 14, 1997
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1992
Last certification
Jan 1, 1992
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 21, 1977 in NY
Enrollment address
6114 US Highway 301 S
Four Oaks, NC 27524-7417

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

Other NPIs on the same Medicare enrollment 19

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

View all 19

National Provider Directory

National Provider Directory

Locations

306 Beaman St
Clinton, NC 28328
Phone (910) 521-9557

194 Tomahawk Hwy
Harrells, NC 28444
Phone (910) 532-4106

500 S Fayetteville St
Salemburg, NC 28385
Phone (910) 525-4628

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
Nancy J Blackman Individual Corporate DirectorBoard of Directors Nov 17, 2005
Phillip E Mills Individual Corporate DirectorBoard of Directors Oct 1, 2005
Vanessa a Burgess Individual Corporate DirectorBoard of Directors Jul 24, 2008
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 Oct 1, 2005
Tamara Dunn Individual Corporate OfficerCoo May 1, 2026
W-2 Managing EmployeeAd; May 1, 2026
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 DirectorBoar of Directors Sep 10, 1975
Spencer McAlpine Individual Corporate DirectorBoard of Directors Mar 17, 2016
William Taylor Individual Corporate OfficerBoard of Directors May 18, 2017
Jose Garcia Individual Corporate DirectorDirector Aug 1, 2019
Mary E Blaizes Individual Corporate DirectorBoard of Directors Oct 1, 2005
William C Ellison Individual Corporate DirectorRevenue Cycle Manager Mar 1, 2022

Practitioners & affiliated clinicians

Practitioners 53

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 53

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780531200000",
    "number": "1427087709",
    "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": "910-567-5342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6114 US HIGHWAY 301 S",
            "city": "FOUR OAKS",
            "state": "NC",
            "postal_code": "275247417",
            "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": "2006-06-30",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Four Oaks, NC

Sources for this page

Verify at the official NPI Registry.