NPIMap

Individual provider Active NPI

Raven Lionel Deloatch, MD

  • Internal Medicine Physician
  • Jackson, NC
National Provider Identifier
1740268598
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
31478 Issued in NC
Practice address
9425 NC Highway 305
Jackson, NC 27845-9679
Phone
(252) 534-1661
Fax
(252) 534-2841
NPI assigned
Jan 3, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 31478 NC Primary

Addresses

Primary practice location

9425 NC Highway 305
Jackson, NC 27845-9679

Mailing address

PO Box 640
Roanoke Rapids, NC 27870-0640
Phone (252) 536-5791

Other identifiers 8

IdentifierTypeStateIssuer
7928324MedicaidNC
D2792OtherNCMEDCOST LLC PROVIDER #
112536OtherNCANTHEM SERVICES PROVIDER#
0454365OtherNCUNITED HEALTH CARE #
289354OtherNCMAMSI PROVIDER #
31478OtherNCNC MEDICAL LICENSE #
110147756OtherNCRAILROAD MEDICARE #
28324OtherNCBLUE CROSS BLUE SHIELD #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050831000877 NC Practitioner - Internal Medicine 2466484241 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Brody School of Medicine at East Carolina University, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rural Health Group IncGroup PAC ID 9739090226, 65 clinicians

Practice addresses (Care Compare)

9425 NC Hwy 305
Jackson, NC 27845-9679
Phone (252) 534-1661

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
31478NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rural Health Group, Inc. Current Accepting new patients
Rural Health Group, Inc. CurrentSince Feb 1, 2015 Accepting new patients
Rural Health Group, Inc. Current Accepting new patients
Rural Health Group, Inc. CurrentSince Feb 1, 2015 Accepting new patients
Rural Health Group, Inc. Current Accepting new patients
Rural Health Group, Inc. Current Accepting new patients
Tar River LTC Group, LLC Past Accepting new patients
Rural Health Group, Inc. Past Accepting new patients

Locations

114 Market St
Enfield, NC 27823
Phone (252) 445-2332

9425 NC Highway 305
Jackson, NC 27845
Phone (252) 534-1661

2066 NC Highway 125
Roanoke Rapids, NC 27870
Phone (252) 536-5000

919 Jr High School Rd
Scotland Neck, NC 27874
Phone (252) 826-3143

Interoperability endpoints

  • Direct secure messaging: raven.deloatch@rhgnc.eclinicaldirectplus.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1740268598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278700640",
            "telephone_number": "252-536-5791",
            "fax_number": "252-536-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9425 NC HIGHWAY 305",
            "city": "JACKSON",
            "state": "NC",
            "postal_code": "278459679",
            "telephone_number": "252-534-1661",
            "fax_number": "252-534-2841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELOATCH",
        "first_name": "RAVEN",
        "middle_name": "LIONEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "31478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7928324",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST LLC PROVIDER #",
            "identifier": "D2792",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM SERVICES PROVIDER#",
            "identifier": "112536",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE #",
            "identifier": "0454365",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI PROVIDER #",
            "identifier": "289354",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC MEDICAL LICENSE #",
            "identifier": "31478",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE #",
            "identifier": "110147756",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD #",
            "identifier": "28324",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, NC

Sources for this page

Verify at the official NPI Registry.