NPIMap

Organization Active NPI

Roanoke Valley Health Services Inc

Doing business as ECU Health Family Medicine - Roanoke Rapids

  • Rural Health Clinic/Center
  • Roanoke Rapids, NC
National Provider Identifier
1720198369
Registry record updated Mar 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ROANOKE VALLEY HEALTH SERVICES INC
Doing business as
ECU Health Family Medicine - Roanoke Rapids
Roanoke Clinic
Practice address
1385 Medical Center Dr
Roanoke Rapids, NC 27870-5130
Phone
(252) 537-9176
Fax
(252) 537-6851
NPI assigned
Aug 30, 2006
Last updated
Mar 18, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2026

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

Authorized official

Name
Anthony Wayne Bartholomew
Title
VP, Operations
Phone
(252) 847-9067

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1385 Medical Center Dr
Roanoke Rapids, NC 27870-5130

Mailing address

1385 Medical Center Dr
Roanoke Rapids, NC 27870-5130
Phone (252) 537-9176

Other names 2

  • ECU Health Family Medicine - Roanoke Rapids Doing business as
  • ROANOKE CLINIC Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030218000014 NC Part A Provider - Rural Health Clinic 4587573159 Practice locations: Roanoke Rapids, NC
O20050119001033 NC Part B Supplier - Clinic/Group Practice 4587573159 Receives reassigned benefits from 9 practitioners
12 other NPIs on this enrollment
Practice locations: Greenville, NC; Knightdale, NC; Roanoke Rapids, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720198369. Details of each certification follow.

Rural health clinic certification: CCN 348941

Legal name
ROANOKE VALLEY HEALTH SERVICES INC
Doing business as
VIDANT FAMILY MEDICINE ROANOKE RAPIDS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 6, 2003
Last certification
Apr 10, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 18, 1994 in NC
Enrollment address
1385 Medical Center Dr
Roanoke Rapids, NC 27870-5130

Other NPIs on the same Medicare enrollment 12

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

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
34D0701413Ecu Health Family Medicine Roanoke Rapids1385 Medical Center Drive, Roanoke Rapids, NC 27870Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Tiffany Mose Individual W-2 Managing Employee Apr 16, 2012
Jerry Townsend Individual Corporate Officer Jun 1, 2019
David S Hughes Individual Corporate Officer Jun 1, 2019
University Health Systems of Eastern Carolina, Inc. Organization, Greenville, NC Corporation, Non-profit Other Jun 1, 2019 100%
Jay T Briley Individual Corporate Officer Jun 1, 2019
Michael R Waldrum Individual Corporate OfficerCeo Chain Home Office Jun 1, 2019
Jason B Harrell Individual Corporate OfficerPresident Aug 31, 2020
W-2 Managing Employee Aug 31, 2020
East Carolina Health Organization, Greenville, NC Corporation, Non-profit Other Jun 1, 2019

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773792000000",
    "number": "1720198369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1385 MEDICAL CENTER DR",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278705130",
            "telephone_number": "252-537-9176",
            "fax_number": "252-537-6851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1385 MEDICAL CENTER DR",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278705130",
            "telephone_number": "252-537-9176",
            "fax_number": "252-537-6851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROANOKE VALLEY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A",
        "authorized_official_last_name": "BARTHOLOMEW",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "VP, OPERATIONS",
        "authorized_official_telephone_number": "252-847-9067"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ECU Health Family Medicine - Roanoke Rapids",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ROANOKE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ROANOKE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke Rapids, NC

Sources for this page

Verify at the official NPI Registry.