Tyrrell County Rural Health Association, Inc.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

TYRRELL COUNTY RURAL HEALTH ASSOCIATION, INC.

Doing business as

DBA - Columbia Medical Center

Practice address

208 North Broad Street
Columbia, NC 27925

Phone

(252) 796-0689

Fax

(252) 796-0690

NPI assigned

Jul 5, 2006

Last updated

Jul 16, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Irene Leibensperger-Cavall, FNP

Title

Medical Director

Phone

(252) 796-0689

Specialties & licenses 1

Addresses

Other names 1

• DBA - Columbia Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477583102. Details of each certification follow.

• CCN 343923 Rural health clinic · Active · Details

Rural health clinic certification: CCN 343923

Legal name

TYRRELL COUNTY RURAL HEALTH ASSOCIATION, INC.

Doing business as

COLUMBIA MEDICAL CENTER

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Oct 20, 1992

Last certification

Sep 14, 2021

Ownership / control type

2B

Organization structure

CorporationNon-profit

Incorporated

Oct 20, 1992 in NC

Enrollment address

208 N Broad Street
Columbia, NC 27925-9705

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 2

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

Owners & managing parties with NPI records 1

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

• Irene Liebensperger-Cavall

  • Family Medicine Physician
  • Columbia, NC
  • NPI 1407942196

  Corporate Director

  CMS ownership

Practitioners 2

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.

• Thomas Calvin Dimartino, MD

  • Family Medicine Physician
  • Edenton, NC
  • NPI 1003809542
  Medicare reassignment Care Compare group NPD
• Irene Liebensperger-Cavall

  • Family Medicine Physician
  • Columbia, NC
  • NPI 1407942196
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531699200000",
    "number": "1477583102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 NORTH BROAD ST",
            "city": "COLUMBIA",
            "state": "NC",
            "postal_code": "279259705",
            "telephone_number": "252-796-0689",
            "fax_number": "252-796-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 NORTH BROAD STREET",
            "city": "COLUMBIA",
            "state": "NC",
            "postal_code": "27925",
            "telephone_number": "252-796-0689",
            "fax_number": "252-796-0690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYRRELL COUNTY RURAL HEALTH ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2018-07-16",
        "status": "A",
        "authorized_official_last_name": "LEIBENSPERGER-CAVALL",
        "authorized_official_first_name": "IRENE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "252-796-0689",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA - Columbia Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DBA - Columbia Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rpa Healthcare (Aging with Advantage Medical Supply)
• Jasmine Spruill, MS, LCSWA
• This Is Life
• Tideland Mental Health Center- Columbia Office
• Tyrrell County Ambulance
• Tyrrell County Schools

• Rural Health Clinic/Center in Columbia, NC
• Providers in Columbia, NC by specialty
• Rural Health Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.