NPIMap

Organization Active NPI

Ocracoke Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ocracoke, NC
National Provider Identifier
1689726101
Registry record updated Nov 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OCRACOKE HEALTH CENTER, INC.
Practice address
305 Back Road
Ocracoke, NC 27960-0543
Phone
(252) 928-1511
Fax
(252) 928-7391
NPI assigned
Jan 17, 2007
Last updated
Nov 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2022

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

Authorized official

Name
Cheryl L BallanceNPI 1548470149
Title
Administrator
Phone
(252) 928-1511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

305 Back Road
Ocracoke, NC 27960-0543

Mailing address

PO Box 543
305 Back Road
Ocracoke, NC 27960-0543
Phone (252) 928-1511

Other identifiers 2

IdentifierTypeStateIssuer
1689726101MedicaidNC
341014OtherNCMEDICARE FQHC

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120611000035 NC Part B Supplier - Clinic/Group Practice 8224221973 Receives reassigned benefits from 3 practitioners
Practice locations: Ocracoke, NC
O20140423001631 NC Part A Provider - Federally Qualified Health Center (FQHC) 8224221973 Practice locations: Ocracoke, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689726101. Details of each certification follow.

Federally qualified health center certification: CCN 341014

Legal name
OCRACOKE HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 23, 2014
Last certification
Apr 23, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 25, 1980 in NC
Enrollment address
305 Back Rd
Ocracoke, NC 27960-0543

Other NPIs with the same Medicare PAC ID 4

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

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
34D0242621Ocracoke Health Center305 Back Road, Ocracoke, NC 27960Certificate of waiverJan 2, 2028

National Provider Directory

National Provider Directory
Tax ID family
Ocracoke Health Center Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Susan Pentz Individual Corporate Officer Nov 1, 2013
Jamie T Carter Individual W-2 Managing EmployeeAd; Feb 1, 2026 100%
Operational/Managerial ControlCeo Nov 1, 2013 100%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Okracoke Health CenterEngelhard, NC, CCN 341011 Federally qualified health center Operational/Managerial Control (100%) Aug 15, 2016
Manteo Community Health CenterManteo, NC, CCN B61011 Federally qualified health center Operational/Managerial Control (100%) Jul 10, 2023

Owned or controlled facilities with NPI records 2

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

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": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668643200000",
    "number": "1689726101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 543",
            "address_2": "305 BACK ROAD",
            "city": "OCRACOKE",
            "state": "NC",
            "postal_code": "279600543",
            "telephone_number": "252-928-1511",
            "fax_number": "252-928-7391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 BACK ROAD",
            "city": "OCRACOKE",
            "state": "NC",
            "postal_code": "279600543",
            "telephone_number": "252-928-1511",
            "fax_number": "252-928-7391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCRACOKE HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A",
        "authorized_official_last_name": "BALLANCE",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "252-928-1511"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689726101",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FQHC",
            "identifier": "341014",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocracoke, NC

Sources for this page

Verify at the official NPI Registry.