NPIMap

Organization Active NPI

Granville Health System

Doing business as Granville Behavioral Health Services

  • Psychiatry Physician
  • Oxford, NC
National Provider Identifier
1710089164
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
GRANVILLE HEALTH SYSTEM
Doing business as
Granville Behavioral Health Services
Practice address
102 Professional Park Ste a
Oxford, NC 27565-2554
Phone
(919) 690-3217
Fax
(919) 690-3218
NPI assigned
Sep 5, 2006
Last updated
Oct 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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

Authorized official

Name
Jamie Purvis
Title
Cfo
Phone
(919) 690-3237

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X

Addresses

Primary practice location

102 Professional Park Ste a
Oxford, NC 27565-2554

Mailing address

PO Box 947
Oxford, NC 27565-0947
Phone (919) 690-3000

Other identifiers 1

IdentifierTypeStateIssuer
6005338MedicaidNC

Other names 1

  • Granville Behavioral Health Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000034 NC Part B Supplier - Clinic/Group Practice 1052223757 Receives reassigned benefits from 3 practitioners
Practice locations: Oxford, NC

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Granville Behavioral Health11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

1614 NC Highway 56
Creedmoor, NC 27522
Phone (919) 528-7171

104 Professional Park
Ste C
Oxford, NC 27565

110 Professional Park
Oxford, NC 27565
Phone (919) 693-6541

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
South Granville Primary CareCreedmoor, NC, CCN 343436 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2008
Jul 1, 2008
Granville Internal Medicine and GeriatricsOxford, NC, CCN 343437 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 2009
Aug 1, 2009

Owned or controlled facilities with NPI records 2

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

  • Granville Health System

    dba South Granville Primary Care

    • Rural Health Clinic/Center
    • Creedmoor, NC
    • NPI 1265430854

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Granville Health System

    dba Granville Internal Medicine & Geriatrics

    • Rural Health Clinic/Center
    • Oxford, NC
    • NPI 1811999055

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728604800000",
    "number": "1710089164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 947",
            "city": "OXFORD",
            "state": "NC",
            "postal_code": "275650947",
            "telephone_number": "919-690-3000",
            "fax_number": "919-603-1097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 PROFESSIONAL PARK STE A",
            "city": "OXFORD",
            "state": "NC",
            "postal_code": "275652554",
            "telephone_number": "919-690-3217",
            "fax_number": "919-690-3218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANVILLE HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A",
        "authorized_official_last_name": "PURVIS",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "919-690-3237"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005338",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Granville Behavioral Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Granville Behavioral Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oxford, NC

Sources for this page

Verify at the official NPI Registry.