Rural Health Group, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Jackson, NC
NPI 1689626178 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1689626178
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- RURAL HEALTH GROUP, INC.
- Practice address
- 9425 NC 305 Hwy
Jackson, NC 27845 - Phone
- (252) 534-1661
- Fax
- (252) 534-2841
- NPI assigned
- May 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Judy Belch Beasley
- Title
- Corporate Compliance Officer
- Phone
- (252) 536-5791
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 17
Other NPIs with the same Medicare PAC ID 18
Practitioners 122
-
Christina Jene Allen, PA-C
-
Susan L Baker, FNP-BC
-
Laquita Balmer, NP
-
Erin Gillies Bristow, NP-C
-
Sherby Brown, ARNP-C
-
Julie Ann Campbell-Barnes, FNP-C
-
Eilis Clark, MD
-
Mary Lamonica Cooper, FNP-C
-
Paula Shearin Elias, AGNP
-
Amanda Aydelette Futrell, PA-C
-
Ronald Eugene Hughes, M.D
-
Sharon Faye Lynch-Jones, FNP-C
-
Holly Virginia Mackenna, M.D.
-
Vijayalakshmi Mamedi, M.D.
-
Richard Anthony Moore II, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0242033 | Rural Health Group at Jackson | Provider-performed microscopy | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Federally qualified health center certification: CCN 341874
- Legal name
- RURAL HEALTH GROUP INC
- Doing business as
- RURAL HEALTH GROUP AT JACKSON
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 30, 2003
- Last certification
- Oct 30, 2003
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 4, 1985 in NC
- Enrollment address
- 9425 NC Highway 305
Jackson, NC 27845-9679
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Chester Bruce Williams |
Corporate Director |
Sep 24, 2015 | |
| Gary Lavern Wingfield |
Corporate Director |
Aug 18, 2019 | |
| Krystian Gayle Latham |
Corporate Director |
Feb 22, 2022 | |
| Ella Green Viverette |
Corporate Director | Nov 15, 2004 | |
| Jimille Evans Mills |
Corporate Director |
Jan 1, 2021 | |
| Patrinia Mitchell Deloatch |
W-2 Managing Employee |
Apr 22, 2024 | |
| Cynthia Lynette Brown |
Corporate Director |
Oct 30, 2003 | |
| Yvonne Long Gee |
Corporate Officer |
Jan 27, 2018 | |
| Wilhelmena Rae Herritage Mitchell |
Corporate Director |
Nov 15, 2004 | |
| Sara Myrick Council |
Corporate Director |
Mar 17, 2019 | |
| Clyde Anthony Johnston |
Corporate Director |
Nov 15, 2004 | |
| Lutricia Lynch Lewis |
Corporate Director |
Oct 30, 2003 | |
| Audrey Lee Hardy |
Corporate Director |
Sep 24, 2015 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Rural Health Group at Henderson |
Federally qualified health center | Operational/Managerial Control | Aug 31, 2009 |
| Rural Health Group at Enfield |
Federally qualified health center | Operational/Managerial Control | Jul 2, 2012 |
| Rural Health Group at Halifax Community College |
Federally qualified health center | Operational/Managerial Control | Feb 13, 2018 |
| Rural Health Group at Drugco Express |
Federally qualified health center | Operational/Managerial Control | Jul 17, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031009000004 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 9739090226 | Practice locations: Jackson, NC |
| O20050708000124 | NC | Part B Supplier - Clinic/Group Practice | 9739090226 |
Receives reassigned benefits from 81 practitioners 17 other NPIs on this enrollment Practice locations: Enfield, NC; Whitakers, NC; Weldon, NC; Stovall, NC; Scotland Neck, NC; Roanoke Rapids, NC; Norlina, NC; Littleton, NC… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
9425 NC 305 Hwy
Jackson, NC 27845
Mailing address
PO Box 640
Roanoke Rapids, NC 27870-0640
Phone (252) 536-5791
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02547 | Other | NC | BCBS OF NORTH CAROLINA |
| 344592 | Medicaid | NC |
Other names
- Rural Health Group at Jackson
Other providers in Jackson, NC
- Jenny Michelle Reine-Baskett
- Residential Loving Care Group Home
- Terri Martin Revelle
- Karren Boone Ricks
- Rural Health Group, Inc.
- Sega Sikod
- Lauren Simmons
- Cheryl Cherry Stevenson
- Tar River LTC Group, LLC
- The Renaissance House
All providers in Jackson, NC · Federally Qualified Health Center (FQHC) 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 Aug 22, 2020. 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.