NPIMap

Organization Active NPI

Bladen Healthcare LLC

Doing business as CFV Bladen County Hospital-Swing Bed Unit

  • Critical Access Hospital
  • Elizabethtown, NC
National Provider Identifier
1548436272
Registry record updated May 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
H0154 Issued in NC
Legal business name
BLADEN HEALTHCARE LLC
Doing business as
CFV Bladen County Hospital-Swing Bed Unit
Cape Fear Valley - Bladen County Hospital (Swing Bed Unit)
Practice address
501 S Poplar St
Elizabethtown, NC 28337-9375
Phone
(910) 862-5179
Fax
(910) 862-5129
NPI assigned
May 2, 2008
Last updated
May 29, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BLADEN HEALTHCARE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 29, 2020

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X
Critical Access Hospital 282NC0060X H0154 NC Primary

Addresses

Primary practice location

501 S Poplar St
Elizabethtown, NC 28337-9375

Mailing address

501 S Poplar St
Elizabethtown, NC 28337-9375
Phone (910) 862-5179

Other identifiers 1

IdentifierTypeStateIssuer
3461315MedicaidNC

Other names 2

  • CFV Bladen County Hospital-Swing Bed Unit Doing business as
  • Cape Fear Valley - Bladen County Hospital (Swing Bed Unit) Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090717000051 NC Part A Provider - Critical Access Hospital 6800967969 Practice locations: Elizabethtown, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548436272. Details of each certification follow.

Hospital certification: CCN 34Z315

Legal name
BLADEN HEALTHCARE LLC
Doing business as
CAPE FEAR VALLEY - BLADEN COUNTY HOSPITAL
Organization structure
LLCNon-profit
Incorporated
Mar 20, 2008 in NC
Enrollment address
501 South Poplar St
Elizabethtown, NC 28337-9375
Other Hospital Practice Location

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).

National Provider Directory

National Provider Directory
Tax ID family
Bladen Healthcare LLC10 organizations share this tax ID, including this one
Part of
Bladen Healthcare LLC

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 25

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

NameRoleSinceShare
Veronica Brunell Jones Individual Corporate OfficerTrustee Dec 1, 2022
Operational/Managerial ControlTrustee Dec 1, 2022
Chukwuemeka O Chima Individual Corporate OfficerTrustee Jul 29, 2022
Operational/Managerial ControlTrustee Jul 29, 2022
Shannon Alane Matthews Individual Corporate OfficerTrustee Dec 1, 2022
Operational/Managerial ControlTrustee Dec 1, 2022
Jeannette Council Individual Contracted Managing EmployeeTrustee Jun 1, 2008
Corporate OfficerTrustee Jun 1, 2008
Corporate Director Jun 1, 2008
Ryan Aul Individual Corporate OfficerTrustee Jul 29, 2022
Operational/Managerial ControlTrustee Jul 29, 2022
Michael Reesal Jones Individual W-2 Managing EmployeeTrustee Jul 29, 2022
Operational/Managerial ControlTrustee Jul 29, 2022
Cumberland County Hospital System Inc Organization, Fayetteville, NC Operational/Managerial Control Jun 1, 2008
Pamela Suggs Story Individual Corporate OfficerTrustee Dec 1, 2022
Operational/Managerial ControlTrustee Dec 1, 2022
Glenn Adams Individual Corporate OfficerTrustee Jul 29, 2022
Operational/Managerial ControlTrustee Jul 29, 2022
Michael Boose Individual Corporate OfficerTrustee Jul 29, 2022
Operational/Managerial ControlTrustee Jul 29, 2022
Girum K Feyissa Individual W-2 Managing EmployeeTrustee Jul 29, 2022
Operational/Managerial ControlTrustee Jul 29, 2022
Tammy Thurman Individual Corporate OfficerTrustee Jul 29, 2022
Operational/Managerial ControlTrustee Jul 29, 2022
Michael Nagowski Individual Corporate DirectorBoard Jun 1, 2008
Sanjay B Shah Individual Corporate OfficerTrustee Dec 1, 2022
Operational/Managerial ControlTrustee Dec 1, 2022
Bret Johnson Individual W-2 Managing EmployeeCfo Jul 29, 2022
Operational/Managerial ControlCfo Jul 29, 2022
Myron Scott Strickland Individual Corporate OfficerTrustee Jul 29, 2022
Operational/Managerial ControlTrustee Jul 29, 2022
Joseph Fiser Individual W-2 Managing EmployeeVP Rev Cycle/Managed Care Aug 20, 2021
William Faircloth Individual Corporate OfficerTrustee Jul 29, 2022
Operational/Managerial ControlTrustee Jul 29, 2022
Warren McDonald Individual Corporate OfficerBoard of Director Jul 29, 2022
Operational/Managerial ControlBoard of Director Jul 29, 2022
Samuel a Fleishman Individual W-2 Managing EmployeeMedical Director Jul 29, 2022
Operational/Managerial ControlMedical Director Jul 29, 2022
James Keefe Individual Corporate OfficerTrustee Jul 29, 2022
Operational/Managerial ControlTrustee Jul 29, 2022
Murtis Worth Individual Corporate OfficerTrustee Jul 29, 2022
Operational/Managerial ControlTrustee Jul 29, 2022
Toni Stewart Individual Corporate OfficerTrustee Jul 29, 2022
Operational/Managerial ControlTrustee Jul 29, 2022
Alicia Monae Marks Flowers Individual Corporate OfficerBoard Chair Dec 1, 2022
Corporate DirectorBoard Chair Dec 1, 2022
Operational/Managerial ControlBoard Chair Dec 1, 2022
Bradley J Broussard Individual Corporate DirectorBoard Oct 31, 2013

Owners & managing parties with NPI records 17

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

View all 17

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

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1209686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590710400000",
    "number": "1548436272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S POPLAR ST",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283379375",
            "telephone_number": "910-862-5179",
            "fax_number": "910-862-5129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S POPLAR ST",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283379375",
            "telephone_number": "910-862-5179",
            "fax_number": "910-862-5129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLADEN HEALTHCARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLADEN HEALTHCARE, LLC",
        "enumeration_date": "2008-05-02",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NC",
            "license": "H0154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3461315",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CFV Bladen County Hospital-Swing Bed Unit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cape Fear Valley - Bladen County Hospital (Swing Bed Unit)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elizabethtown, NC

Sources for this page

Verify at the official NPI Registry.