NPIMap

Organization Active NPI

Lifebrite Hospital Group of Stokes, LLC

Doing business as LifeBrite Family Medical of Danbury

  • Rural Health Clinic/Center
  • Danbury, NC
National Provider Identifier
1609319490
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LIFEBRITE HOSPITAL GROUP OF STOKES, LLC
Doing business as
LifeBrite Family Medical of Danbury
Practice address
1570 NC 8 and 89 Hwy N
Danbury, NC 27016-7360
Phone
(336) 593-8281
Fax
(336) 593-5282
NPI assigned
Nov 28, 2016
Last updated
Feb 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2021

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

Authorized official

Name
Mr. Christian Fletcher
Title
Ceo
Phone
(336) 593-5311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1570 NC 8 and 89 Hwy N
Danbury, NC 27016-7360

Mailing address

1570 NC 8 and 89 Hwy N
Danbury, NC 27016-7360
Phone (336) 593-5311

Other identifiers 3

IdentifierTypeStateIssuer
H0165OtherNCHOSPITAL LICENSURE
G557OtherNCMEDICARE PART B PTAN
343447OtherNCPTAN

Other names 1

  • LifeBrite Family Medical of Danbury Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170208002332 NC Part A Provider - Rural Health Clinic 8921380759 Practice locations: Danbury, NC
O20170220001211 NC Part B Supplier - Clinic/Group Practice 8921380759 Receives reassigned benefits from 29 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: King, NC; Pine Hall, NC; Danbury, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609319490. Details of each certification follow.

Rural health clinic certification: CCN 343447

Legal name
LIFEBRITE HOSPITAL GROUP OF STOKES LLC
Doing business as
LIFEBRITE FAMILY MEDICAL OF DANBURY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 28, 2012
Last certification
Feb 10, 2025
Ownership / control type
1B
Most recent change of ownership
Jan 30, 2017 (1 total)
Organization structure
LLCProprietary
Incorporated
Oct 12, 2016 in GA
Enrollment address
1570 NC 8 & 89 Hwy North
Danbury, NC 27016-7360
Related CCNs
341317

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Lifebrite Hospital Group of Stokes LLC10 organizations share this tax ID, including this one

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 7

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

NameRoleSinceShare
Lifebrite Hospital Group LLC Organization, Brookhaven, GA LLC, For-profit 5% Or Greater Direct Ownership Interest Oct 12, 2016 100%
Operational/Managerial Control Oct 12, 2016
Christian Fletcher Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 46%
Corporate OfficerCeo Jan 30, 2017
Operational/Managerial ControlCeo Jan 30, 2017
Pamela Tillman Individual W-2 Managing EmployeeAdministrator Jan 30, 2017
Amber D Fletcher Individual Corporate OfficerCoo Jan 30, 2017
Operational/Managerial ControlCoo Jan 30, 2017
Fletcher 2018 Family Trust Organization, Atlanta, GA 5% Or Greater Indirect Ownership Interest Dec 28, 2018 49%
Amber Dominique Fletcher 2018 Trust Organization, Atlanta, GA 5% Or Greater Indirect Ownership Interest Dec 28, 2018 5%
Lifebrite Laboratories, LLC Organization, Brookhaven, GA LLC, For-profit 5% Or Greater Indirect Ownership Interest Jan 30, 2017 100%

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 1

DateEventCounterparty
Jan 30, 2017 Change of OwnershipThis provider was the buyer Pioneer Family Medical of DanburyCCN 343447, NC, NPI 1912294687

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 7

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": "1480291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612224000000",
    "number": "1609319490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 NC 8 AND 89 HWY N",
            "city": "DANBURY",
            "state": "NC",
            "postal_code": "270167360",
            "telephone_number": "336-593-5311",
            "fax_number": "336-593-5350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 NC 8 AND 89 HWY N",
            "city": "DANBURY",
            "state": "NC",
            "postal_code": "270167360",
            "telephone_number": "336-593-8281",
            "fax_number": "336-593-5282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRITE HOSPITAL GROUP OF STOKES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-28",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-593-5311",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPITAL LICENSURE",
            "identifier": "H0165",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B PTAN",
            "identifier": "G557",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "343447",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeBrite Family Medical of Danbury",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LifeBrite Family Medical of Danbury",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Danbury, NC

Sources for this page

Verify at the official NPI Registry.