DLP Wilson Physician Practices LLC
Organization Active NPI Rural Health Clinic/Center · Bailey, NC
NPI 1629753231 · NPPES record last updated Sep 27, 2024
Key facts
- NPI
- 1629753231
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- DLP WILSON PHYSICIAN PRACTICES LLC
- Practice address
- 6321 Deans St
Bailey, NC 27807-8641 - Phone
- (252) 235-4181
- NPI assigned
- Jun 20, 2023
- Organization subpart
- No
Authorized official
- Name
- Charlotte Lawrence
- Title
- Secretary
- Phone
- (615) 920-7000
Owners & managing parties with NPI records 2
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 2
Member of 1
Facilities with the same owner 202
Practitioners 37
-
Kent Thomas Anderson, M.D.
-
Jordan Thomas Brady, M.D.
-
Natalie Tamara Clarke, PMHNP
-
Chanson Albert Devaul, D.O.
-
James Milton Fitch, PA-C
-
Brittany Wooten Fulghum, AGNP
-
Christopher Michael Gal, M.D.
-
Brooke Renee Lindsay, PA-C
-
Tyechia Shenell Lynch, FNP-C
-
Patricia Maria Mendoza, FNP-C
-
William Ryan Mitchell, M.D.
-
Crystal Jenita Montague, N.P.
-
Ramesh Mutyala, M.D.
-
Hai Viet-Nguyen Salfity, M.D.
-
Emmanuel Olushola Uloko Sr., PMHNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0671311 | Bailey Primary Care | Provider-performed microscopy | Mar 25, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Rural health clinic certification: CCN 348973
- Legal name
- DLP WILSON PHYSICIAN PRACTICES LLC
- Doing business as
- BAILEY PRIMARY CARE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 28, 2023
- Last certification
- Dec 28, 2023
- Ownership / control type
- 1B
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 19, 2013 in DE
- Enrollment address
- 6321 Deans St
Bailey, NC 27807-8641
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Lifepoint Holdings 2 LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 77% |
| DLP Wilson Medical Center, LLC |
5% Or Greater Direct Ownership Interest | Jul 1, 2023 | 100% |
| Pamela Kane |
Corporate Officer |
Jul 1, 2023 | |
| Wilson Medical Center, Inc. |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 20% |
| DSB Acquisition LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 77% |
| Laura C Hinson |
Corporate Officer |
Mar 12, 2025 | |
| Lifepoint Hospitals Holdings LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 77% |
| DLP Wilson Holding Company LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 100% |
| DLP Healthcare LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 80% |
| Historic Lifepoint Hospitals, LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 77% |
| Lifepoint Health Inc |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 77% |
| Charlotte E Lawrence |
Corporate Officer |
Jul 1, 2023 | |
| DLP Partner LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 77% |
| Klaus Michael Boel |
Corporate Officer |
Aug 19, 2024 | |
| W-2 Managing Employee | Aug 19, 2024 | ||
| John Michael Grooms |
Corporate Officer |
Jul 1, 2023 | |
| Christopher J Monte |
Corporate Officer |
Jul 1, 2023 | |
| Legacy Lifepoint Health LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 77% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140502000396 | NC | Part B Supplier - Clinic/Group Practice | 2567695307 |
Receives reassigned benefits from 84 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Stantonsburg, NC; Wilson, NC; Bailey, NC |
| O20230713002532 | NC | Part a Provider - Rural Health Clinic | 2567695307 | Practice locations: Bailey, NC |
National Provider Directory
- Tax ID family
- DLP Wilson Physician Practices LLC
Locations
6321 Deans St
Bailey, NC 27807
Phone (202) 235-4181
1700 Tarboro St W
Ste 100
Wilson, NC 27893
Phone (252) 399-5300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
6321 Deans St
Bailey, NC 27807-8641
Mailing address
330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000
Other names
- Bailey Primary Care
Other providers in Bailey, NC
- Theodore George Brna Jr.
- Sonya Simmons Bullock
- Cornerstone Community Support Services, Inc.
- Kelly P Day
- Divinity Healthcare Services, Inc
- Renee' Stewart Hannah
- Brittian Marie Hinson
- Just 4 Today Services, Inc
- Jane Muthoni Kaara
- Lighten the Load Elder Care
All providers in Bailey, NC · Rural Health Clinic/Center in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.