NPIMap

Organization Active NPI

Henderson County Hospital Corporation

  • Federally Qualified Health Center (FQHC)
  • Etowah, NC
National Provider Identifier
1609515220
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HENDERSON COUNTY HOSPITAL CORPORATION
Practice address
6503 Brevard Rd
Etowah, NC 28729-8739
Phone
(828) 890-4156
Fax
(828) 891-9276
NPI assigned
Jun 1, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Authorized official

Name
Mr. Michael Lynn Sunday Jr.
Title
VP, Chief Financial Officer
Phone
(828) 696-1175

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

6503 Brevard Rd
Etowah, NC 28729-8739

Mailing address

5221 Paramount Pkwy Ste 440
Morrisville, NC 27560-5491
Phone (984) 974-1190

Other names 1

  • Pardee BlueMD-6503 Brevard Road Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20221110003085 NC Part A Provider - Federally Qualified Health Center (FQHC) 8123938115 Practice locations: Etowah, NC
O20221130000321 NC Part B Supplier - Clinic/Group Practice 8123938115 Receives reassigned benefits from 3 practitioners
Practice locations: Etowah, NC

Federally qualified health center certification: CCN 341189

Legal name
HENDERSON COUNTY HOSPITAL CORPORATION
Doing business as
PARDEE BLUEMD-6503 BREVARD ROAD
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 15, 2022
Last certification
Sep 15, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 24, 1998 in NC
Enrollment address
6503 Brevard Rd
Etowah, NC 28729-8739

Other NPIs with the same Medicare PAC ID 19

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

View all 19

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
34D1001767Pardee Bluemd6503 Brevard Road, Etowah, NC 28729Provider-performed microscopyJan 6, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Andrea Vivian Bolanos Padilla Individual Corporate DirectorBoard of Director Nov 1, 2021
Erik a Emaus Individual Corporate DirectorBoard Member Jul 1, 2025
John Gould Individual Corporate DirectorBoard of Director Nov 1, 2021
Hyatt James Chandler Individual Corporate DirectorBoard of Director Nov 1, 2021
Richard W Hudspeth Individual Corporate DirectorBoard of Director Oct 20, 2022
Marilyn Allison Gordon Individual Corporate DirectorBoard of Director Oct 1, 2022
James Stevens Brissie Individual Corporate DirectorBoard of Director Nov 1, 2022
County of Henderson Organization, Hendersonville, NC 5% Or Greater Direct Ownership Interest Apr 24, 1998 100%
University of North Carolina Health Care System Organization, Morrisville, NC Corporation Operational/Managerial Control Jun 22, 2011 100%
Hubbard Thomas Thompson Individual Corporate DirectorBoard of Director Nov 1, 2021
Suzanne Johnna Reed Individual Corporate OfficerChief Executive Officer May 1, 2022
Laura Ward Individual W-2 Managing EmployeeDirector of Practice Operations May 1, 2022
Maurean Yates Burritt Adams Individual Corporate DirectorBoard Member Jul 1, 2025
Maurice Lamont Jones Individual Corporate DirectorBoard Member Jul 1, 2025
Michael Lynn Sunday Individual Corporate OfficerChief Financial Officer, Vice Pres May 1, 2022
Orr Tamela Albrecht Individual Corporate DirectorBoard of Director Mar 1, 2024
Gregory S McCarty Individual Corporate OfficerChief Medical Officer May 1, 2022
Carla Jayne Icenhower Individual Corporate DirectorBoard Member Jul 1, 2025

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pardee Home CareFlat Rock, NC, CCN 347028 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 24, 1998
Apr 24, 1998

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 44

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

View all 44

Practitioners & affiliated clinicians

Practitioners 234

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 234

NPI Registry JSON

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

{
    "created_epoch": "1654041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1609515220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5221 PARAMOUNT PKWY STE 440",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275605491",
            "telephone_number": "984-974-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6503 BREVARD RD",
            "city": "ETOWAH",
            "state": "NC",
            "postal_code": "287298739",
            "telephone_number": "828-890-4156",
            "fax_number": "828-891-9276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON COUNTY HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-01",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "SUNDAY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "VP, CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "828-696-1175",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pardee BlueMD-6503 Brevard Road",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pardee BlueMD-6503 Brevard Road",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Etowah, NC

Sources for this page

Verify at the official NPI Registry.