Rural Health Group, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Roanoke Rapids, NC
NPI 1720030232 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1720030232
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- RURAL HEALTH GROUP, INC.
- Practice address
- 2066 Hwy 125
Roanoke Rapids, NC 27870 - Phone
- (252) 536-5000
- Fax
- (252) 536-2258
- NPI assigned
- May 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Judy Belch Beasley
- Title
- Corporate Compliance Officer
- Phone
- (252) 536-5791
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 17
Other NPIs with the same Medicare PAC ID 18
Practitioners 74
-
Joseph Antinori, M.D.
-
Susan L Baker, FNP-BC
-
Sherby Brown, ARNP-C
-
Sonya Simmons Bullock, PA-C
-
Julie Ann Campbell-Barnes, FNP-C
-
Eilis Clark, MD
-
Mary Lamonica Cooper, FNP-C
-
Paula Shearin Elias, AGNP
-
Sharon Faye Lynch-Jones, FNP-C
-
Holly Virginia Mackenna, M.D.
-
Vijayalakshmi Mamedi, M.D.
-
Richard Anthony Moore II, M.D.
-
Jennifer Pernesky, FNP
-
Laura Thompson Pittman, FNP-BC
-
Karen Lee Stimson, LCSW
-
Cassandra D Storey, PA-C
-
Dawn Webb Welch, MSW, LCSW
-
Mona Xiao, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NC
Federally qualified health center certification: CCN 341875
- Legal name
- RURAL HEALTH GROUP INC
- Doing business as
- RURAL HEALTH GROUP AT ROANOKE RAPIDS
- 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
- Corporation · Non-profit
- Incorporated
- Jan 4, 1985 in NC
- Enrollment address
- 2066 NC Highway 125
Roanoke Rapids, NC 27870-9436
Federally qualified health center certification: CCN 341004
- Legal name
- RURAL HEALTH GROUP INC
- Doing business as
- RURAL HEALTH GROUP AT ROANOKE RAPIDS/PEDIATRICS
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 20, 2012
- Last certification
- Dec 20, 2012
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 4, 1985 in NC
- Enrollment address
- 2064 NC Highway 125
Roanoke Rapids, NC 27870-9436
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Chester Bruce Williams |
Corporate Director |
Mar 8, 2016 | |
| Corporate Director |
Mar 8, 2016 | ||
| Gary Lavern Wingfield |
Corporate Director |
Aug 18, 2019 | |
| Corporate Director |
Aug 18, 2019 | ||
| Krystian Gayle Latham |
Corporate Director |
Feb 24, 2022 | |
| Corporate Director |
Feb 24, 2022 | ||
| Ella Green Viverette |
Corporate Director |
Nov 15, 2004 | |
| Corporate Director |
Nov 1, 2012 | ||
| Jimille Evans Mills |
Corporate Director |
Jan 28, 2021 | |
| Corporate Director |
Jan 28, 2021 | ||
| Patrinia Mitchell Deloatch |
W-2 Managing Employee |
Apr 22, 2024 | |
| Cynthia Lynette Brown |
Corporate Director |
Nov 4, 2003 | |
| Corporate Director |
Nov 1, 2012 | ||
| Yvonne Long Gee |
Corporate Officer |
Jan 27, 2018 | |
| Wilhelmena Rae Herritage Mitchell |
Corporate Director |
Nov 15, 2004 | |
| Corporate Director |
Nov 1, 2012 | ||
| Sara Myrick Council |
Corporate Director |
Mar 17, 2019 | |
| Corporate Director |
Mar 17, 2019 | ||
| Clyde Anthony Johnston |
Corporate Director |
Nov 15, 2004 | |
| Corporate Director |
Nov 1, 2012 | ||
| Lutricia Lynch Lewis |
Corporate Director |
Nov 4, 2003 | |
| Corporate Director |
Nov 1, 2012 | ||
| Audrey Lee Hardy |
Corporate Director |
Mar 8, 2016 | |
| Corporate Director |
Mar 8, 2016 | ||
| Willie McKinley Greene |
Corporate Director |
Nov 1, 2012 | |
| Judy Belch Beasley |
W-2 Managing Employee |
Nov 1, 2012 | |
| Jimmie Lewis Sidberry |
Corporate Director |
Dec 20, 2013 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Rural Health Group at Henderson |
Federally qualified health center | Operational/Managerial Control | Aug 31, 2009 |
| Rural Health Group at Enfield |
Federally qualified health center | Operational/Managerial Control | Jul 2, 2012 |
| Rural Health Group at Halifax Community College |
Federally qualified health center | Operational/Managerial Control | Feb 13, 2018 |
| Rural Health Group at Drugco Express |
Federally qualified health center | Operational/Managerial Control | Jul 17, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030818000036 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 9739090226 | Practice locations: Roanoke Rapids, NC |
| O20050708000124 | NC | Part B Supplier - Clinic/Group Practice | 9739090226 |
Receives reassigned benefits from 81 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Enfield, NC; Whitakers, NC; Weldon, NC; Stovall, NC; Scotland Neck, NC; Roanoke Rapids, NC; Norlina, NC; Littleton, NC… |
| O20121119000475 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 9739090226 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Roanoke Rapids, NC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
2066 Hwy 125
Roanoke Rapids, NC 27870
Mailing address
PO Box 640
Roanoke Rapids, NC 27870-0640
Phone (252) 536-5791
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02609 | Other | NC | BCBS OF NORTH CAROLINA |
| 344593 | Medicaid | NC |
Other names
- Rural Health Group at Roanoke Rapids
Other providers in Roanoke Rapids, NC
- Rural Health Group, Inc.
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- Rural Health Group, Inc.
- Rural Health Group, Inc.
- Rural Health Group, Inc.
- Roslyn Yvonne Russell
- Ligaya Jadloc Rutledge
- Cheryl M Sablon
- Zainab Saddiq
All providers in Roanoke Rapids, NC · Federally Qualified Health Center (FQHC) 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 Aug 22, 2020. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.