Robersonville Physicians PC
Organization Active NPI Primary Care Clinic/Center · Robersonville, NC
NPI 1700075348 · NPPES record last updated Feb 2, 2022
Key facts
- NPI
- 1700075348
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- 9900506 (NC)
- Legal business name
- ROBERSONVILLE PHYSICIANS PC
- Practice address
- 504 N Main St
Robersonville, NC 27871-9567 - Phone
- (252) 795-5555
- Fax
- (252) 795-5566
- NPI assigned
- Oct 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Thomas Joseph Gennosa, MD
- Title
- Owner
- Phone
- (252) 795-5555
Practitioners 5
-
Hannah Sarah Lyttle, FNP-C
-
Jennifer L Baker, PA-C
-
Lisa Gennosa, PA-C
-
Delphine Zelaski, P.A.C.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D1006468 | Robersonville Physicians PC | Provider-performed microscopy | Nov 21, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090623000396 | NC | Part B Supplier - Clinic/Group Practice | 8325199805 |
Receives reassigned benefits from 5 practitioners Practice locations: Tarboro, NC; Robersonville, NC |
National Provider Directory
Locations
504 N Main St
Robersonville, NC 27871
Phone (252) 795-5555
107 W Saint John St
Tarboro, NC 27886
Phone (252) 823-4300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 9900506 | NC | Yes |
Addresses
Primary practice location
504 N Main St
Robersonville, NC 27871-9567
Mailing address
504 N Main St
Robersonville, NC 27871-9567
Phone (252) 795-5555
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8912294 | Medicaid | NC |
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- Peggy'S Home Health Care, Inc.
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- Peggy'S Home Health Service
- Prosource Therapeutics, LLC
- Rha Health Services NC LLC
- Robersonville Psychosocial Rehabilitation, LLC
- Shadows Community Support Center LLC
- Soaringabovesocietalstandardsinc.
- Spectrum of Martin County, LTD
- Total Renal Care of North Carolina LLC
All providers in Robersonville, NC · Primary Care 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 Feb 2, 2022. 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.
- 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.