NPIMap

Organization Active NPI

Rural Health Group, Inc.

Doing business as Rural Health Group at Jackson

  • Federally Qualified Health Center (FQHC)
  • Jackson, NC
National Provider Identifier
1689626178
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL HEALTH GROUP, INC.
Doing business as
Rural Health Group at Jackson
Practice address
9425 NC 305 Hwy
Jackson, NC 27845
Phone
(252) 534-1661
Fax
(252) 534-2841
NPI assigned
May 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Judy Belch Beasley
Title
Corporate Compliance Officer
Phone
(252) 536-5791

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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 names 1

  • Rural Health Group at Jackson Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689626178. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jan 4, 1985 in NC
Enrollment address
9425 NC Highway 305
Jackson, NC 27845-9679

Other NPIs with the same Medicare PAC ID 18

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

View all 18

Other NPIs on the same Medicare enrollment 17

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

View all 17

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
34D0242033Rural Health Group at Jackson9425 NC Hwy 305, Jackson, NC 27845Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Chester Bruce Williams Individual Corporate DirectorBoard Member Sep 24, 2015
Gary Lavern Wingfield Individual Corporate DirectorBoard Member Aug 18, 2019
Krystian Gayle Latham Individual Corporate DirectorBoard Member Feb 22, 2022
Ella Green Viverette Individual Corporate Director Nov 15, 2004
Jimille Evans Mills Individual Corporate DirectorBoard Member Jan 1, 2021
Patrinia Mitchell Deloatch Individual W-2 Managing EmployeeDelegated Official Apr 22, 2024
Cynthia Lynette Brown Individual Corporate DirectorBoard Member Oct 30, 2003
Yvonne Long Gee Individual Corporate OfficerCeo Jan 27, 2018
Wilhelmena Rae Herritage Mitchell Individual Corporate DirectorBoard Member Nov 15, 2004
Sara Myrick Council Individual Corporate DirectorBoard Member Mar 17, 2019
Clyde Anthony Johnston Individual Corporate DirectorBoard Member Nov 15, 2004
Lutricia Lynch Lewis Individual Corporate DirectorBoard Member Oct 30, 2003
Audrey Lee Hardy Individual Corporate DirectorBoard Member Sep 24, 2015

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Rural Health Group at HendersonHenderson, NC, CCN 341946 Federally qualified health center Operational/Managerial Control Aug 31, 2009
Rural Health Group at EnfieldEnfield, NC, CCN 341002 Federally qualified health center Operational/Managerial Control Jul 2, 2012
Rural Health Group at Halifax Community CollegeWeldon, NC, CCN 341092 Federally qualified health center Operational/Managerial Control Feb 13, 2018
Rural Health Group at Drugco ExpressRoanoke Rapids, NC, CCN 341091 Federally qualified health center Operational/Managerial Control Jul 17, 2018

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 120

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.

View all 120

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689626178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278700640",
            "telephone_number": "252-536-5791",
            "fax_number": "252-536-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9425 NC 305 HWY",
            "city": "JACKSON",
            "state": "NC",
            "postal_code": "27845",
            "telephone_number": "252-534-1661",
            "fax_number": "252-534-2841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BEASLEY",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "BELCH",
        "authorized_official_title_or_position": "CORPORATE COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "252-536-5791",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rural Health Group at Jackson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, NC

Sources for this page

Verify at the official NPI Registry.