NPIMap

Organization Active NPI

Opportunities Industrialization Center, Inc

Doing business as Oic Family Medical Center at Happy Hill

  • Federally Qualified Health Center (FQHC)
  • Rocky Mount, NC
National Provider Identifier
1528478237
Registry record updated Jul 28, 2015
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 at Happy Hill
Practice address
300 N Grace St
Rocky Mount, NC 27804-5345
Phone
(252) 210-9856
Fax
(252) 212-3497
NPI assigned
May 2, 2014
Last updated
Jul 28, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
OPPORTUNITIES INDUSTRIALIZATION CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 28, 2015

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

Authorized official

Name
Mr. Reuben Blackwell
Title
Chief Executive Officer
Phone
(252) 212-3480

Specialties & licenses 1

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

Addresses

Primary practice location

300 N Grace St
Rocky Mount, NC 27804-5345

Mailing address

PO Box 2723
Rocky Mount, NC 27802-2723
Phone (252) 210-9856

Other names 1

  • OIC FAMILY MEDICAL CENTER AT HAPPY HILL Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140921000016 NC Part B Supplier - Clinic/Group Practice 3173563590 Receives reassigned benefits from 13 practitioners
Practice locations: Rocky Mount, NC
O20141024000898 NC Part A Provider - Federally Qualified Health Center (FQHC) 3173563590 Practice locations: Rocky Mount, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528478237. Details of each certification follow.

Federally qualified health center certification: CCN 341023

Legal name
OPPORTUNITIES INDUSTRIALIZATION CENTER, INC
Doing business as
OIC FAMILY MEDICAL CENTER AT HAPPY HILL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 24, 2014
Last certification
Oct 24, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 19, 1969 in NC
Enrollment address
300N Grace St
Rocky Mount, NC 27804-5345

Other NPIs with the same Medicare PAC ID 5

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

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
34D2079191Oic Family Medical Center at Happy Hill300 N Grace Street, Rocky Mount, NC 27804Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Part of
Opportunities Industrialization Center Inc

Locations

300 N Grace St
Rocky Mount, NC 27804
Phone (252) 210-9856

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
John Michael Baker Individual Corporate OfficerDirector of Integrated Health Servi Jul 6, 2009
Corporate DirectorDirector of Integrated Health Servi Jul 6, 2009
Brenda F Cutchin Individual Corporate Director Jul 1, 2013
Alessandria Cyrena Tucker Individual W-2 Managing EmployeeMedical Credentialing Specialist Dec 2, 2013
Shirley Monk-Jones Individual Operational/Managerial Control Apr 1, 2023
Chayan Tiwari Individual Corporate Director Apr 1, 2023
Reuben Blackwell Individual Corporate OfficerCeo May 5, 2005
Corporate DirectorCeo May 5, 2005
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 Apr 1, 1998
Corporate DirectorCoo Apr 1, 1998
Mary Johnson Mann Individual Corporate Director May 5, 2005
Donna Johnson Individual Corporate DirectorTreasurer May 5, 2005
Hubert D Pope Individual Corporate Director Mar 18, 2008
Andre Knight Individual Corporate Director Jan 1, 2000
Doris K Thorne Individual Corporate Director Jan 1, 2011
Evelyn Wilson Individual Corporate DirectorSecretary May 5, 2005
Leonard Tillery Individual Corporate Director Jul 1, 2013

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 Guardian CourtRocky Mount, NC, CCN 341045 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 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1398988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438041600000",
    "number": "1528478237",
    "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": "252-210-9856",
            "fax_number": "252-212-3497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N GRACE ST",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278045345",
            "telephone_number": "252-210-9856",
            "fax_number": "252-212-3497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPPORTUNITIES INDUSTRIALIZATION CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPPORTUNITIES INDUSTRIALIZATION CENTER, INC",
        "enumeration_date": "2014-05-02",
        "last_updated": "2015-07-28",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "REUBEN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "252-212-3480",
        "authorized_official_name_prefix": "Mr."
    },
    "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 AT HAPPY HILL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rocky Mount, NC

Sources for this page

Verify at the official NPI Registry.