NPIMap

Organization Active NPI

Mid Carolina Family Medicine, P.a.

  • Family Medicine Physician
  • Troy, NC
National Provider Identifier
1497755953
Registry record updated Nov 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
200201193 Issued in NC
Legal business name
MID CAROLINA FAMILY MEDICINE, P.A.
Practice address
1038 Albemarle Rd
Troy, NC 27371-8685
Phone
(910) 572-1785
Fax
(910) 572-1410
NPI assigned
Jul 27, 2005
Last updated
Nov 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2022

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

Authorized official

Name
Dr. Touber Vang, MDNPI 1831181239
Title
President
Phone
(910) 572-1785

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 200201193 NC Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

1038 Albemarle Rd
Troy, NC 27371-8685

Mailing address

1038 Albemarle Rd
Troy, NC 27371-8684
Phone (910) 572-1785

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050816000433 NC Part B Supplier - Clinic/Group Practice 5395775787 Receives reassigned benefits from 2 practitioners
Practice locations: Troy, NC
O20081023000540 NC Part A Provider - Rural Health Clinic 5395775787 Practice locations: Troy, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497755953. Details of each certification follow.

Rural health clinic certification: CCN 348951

Legal name
MID CAROLINA FAMILY MEDICINE, P.A.
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 17, 2009
Last certification
May 29, 2019
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Feb 17, 2005 in ND
Enrollment address
1038 Albemarle Rd
Troy, NC 27371-8684

National Provider Directory

National Provider Directory

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
Judy W Lemonds Individual Corporate OfficerSecretary Treasurer Feb 17, 2015
W-2 Managing EmployeePractice Manager Feb 17, 2005
Janet L Britt Individual 5% Or Greater Direct Ownership Interest Feb 17, 2005 50%
Touber Vang Individual 5% Or Greater Direct Ownership Interest Feb 17, 2005 50%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668643200000",
    "number": "1497755953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1038 ALBEMARLE RD",
            "city": "TROY",
            "state": "NC",
            "postal_code": "273718684",
            "telephone_number": "910-572-1785",
            "fax_number": "910-572-1410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1038 ALBEMARLE RD",
            "city": "TROY",
            "state": "NC",
            "postal_code": "273718685",
            "telephone_number": "910-572-1785",
            "fax_number": "910-572-1410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID CAROLINA FAMILY MEDICINE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-27",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A",
        "authorized_official_last_name": "VANG",
        "authorized_official_first_name": "TOUBER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-572-1785",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200201193",
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, NC

Sources for this page

Verify at the official NPI Registry.