NPIMap

Organization Active NPI

Tri County Community Health Council Inc

  • Federally Qualified Health Center (FQHC)
  • Four Oaks, NC
National Provider Identifier
1700054574
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Practice address
725 Boyette Rd
Four Oaks, NC 27524-7776
Phone
(877) 935-5255
Fax
(910) 236-2118
NPI assigned
Feb 14, 2008
Last updated
Jul 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

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

Authorized official

Name
William Ellison
Title
Revenue Cycle Manager
Phone
(910) 567-7065

Specialties & licenses 1

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

Addresses

Primary practice location

725 Boyette Rd
Four Oaks, NC 27524-7776

Mailing address

PO Box 340
Four Oaks, NC 27524-0340
Phone (910) 567-6194

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040702000780 NC Part B Supplier - Clinic/Group Practice 2163409558 Receives reassigned benefits from 52 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Willard, NC; Tar Heel, NC; Smithfield, NC; Shallotte, NC; Dunn, NC; Salemburg, NC; Ocean Isle Beach, NC; Harrells, NC…
O20120523000148 NC Part A Provider - Federally Qualified Health Center (FQHC) 2163409558 Practice locations: Four Oaks, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700054574. Details of each certification follow.

Federally qualified health center certification: CCN 341961

Legal name
TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Doing business as
COMMWELL OF FOUR OAKS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 7, 2011
Last certification
Sep 7, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 21, 1977 in NC
Enrollment address
725 Boyette Rd
Four Oaks, NC 27524

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 19

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

View all 19

National Provider Directory

National Provider Directory

Locations

100 E Sanders St
Four Oaks, NC 27524
Phone (910) 813-0814

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Nancy J Blackman Individual Corporate Director Jul 15, 2011
Phillip E Mills Individual Corporate Director Jul 15, 2011
Vanessa a Burgess Individual Corporate Director Jul 15, 2011
Raymond Lindsey Individual Corporate DirectorBoard of Directors Oct 14, 2010
Nathan J Tilghman Individual Corporate Director Jul 15, 2011
Mary Crumpler Individual Corporate DirectorBoard of Directors Mar 17, 2015
Silvia a. Cendejas Individual Corporate Director Dec 15, 2011
Gary Herring Individual Corporate DirectorBoard of Directors Mar 17, 2016
Spencer McAlpine Individual Corporate DirectorBoard of Directors Aug 29, 2013
William Taylor Individual Corporate DirectorBoard of Directors May 18, 2017
Jose Garcia Individual Corporate DirectorBoard of Directors Aug 1, 2019
Pamela Tripp Individual Corporate DirectorCeo Jul 15, 2011
W-2 Managing Employee Jul 15, 2011
Mary E Blaizes Individual Corporate Director Jul 15, 2011
William C Ellison Individual Corporate DirectorDirector of Revenue Cycle Mar 1, 2022

Practitioners & affiliated clinicians

Practitioners 2

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": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751846400000",
    "number": "1700054574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 340",
            "city": "FOUR OAKS",
            "state": "NC",
            "postal_code": "275240340",
            "telephone_number": "910-567-6194",
            "fax_number": "910-567-5342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 BOYETTE RD",
            "city": "FOUR OAKS",
            "state": "NC",
            "postal_code": "275247776",
            "telephone_number": "877-935-5255",
            "fax_number": "910-236-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI COUNTY COMMUNITY HEALTH COUNCIL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A",
        "authorized_official_last_name": "ELLISON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "910-567-7065"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Four Oaks, NC

Sources for this page

Verify at the official NPI Registry.