NPIMap

Organization Active NPI

Bluebell Health & Wellness, PLLC

  • Rural Health Clinic/Center
  • Goldsboro, NC
National Provider Identifier
1740940790
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BLUEBELL HEALTH & WELLNESS, PLLC
Practice address
3484 US Highway 13 S
Goldsboro, NC 27530-1025
Phone
(919) 689-2222
NPI assigned
Dec 17, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Authorized official

Name
Jennifer Mazurek, DNP, FNP-BCNPI 1679130074
Title
DNP, FNP-BC
Phone
(252) 903-9974

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

3484 US Highway 13 S
Goldsboro, NC 27530-1025

Mailing address

3484 US Highway 13 S
Goldsboro, NC 27530-1025
Phone (919) 689-2222

Other identifiers 1

IdentifierTypeStateIssuer
5011760OtherNCNURSE PRACTITIONER LICENSE NUMBER

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220317002104 NC Part B Supplier - Clinic/Group Practice 6406241017 Receives reassigned benefits from 2 practitioners
Practice locations: Goldsboro, NC
O20220412002276 NC Part A Provider - Rural Health Clinic 6406241017 Practice locations: Goldsboro, NC

Rural health clinic certification: CCN 348972

Legal name
BLUEBELL HEALTH & WELLNESS PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 1, 2023
Last certification
Aug 1, 2023
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
in NC
Enrollment address
3484 US Highway 13 S
Goldsboro, NC 27530-1025

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
34D2264958Bluebell Health & Wellness, PLLC3484 US Hwy 13 S, Goldsboro, NC 27530Certificate of waiverJul 20, 2028

National Provider Directory

National Provider Directory

Locations

3484 US Highway 13 S
Goldsboro, NC 27530
Phone (252) 903-9974

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Lisa Poandl Individual Corporate Officer Apr 4, 2022
W-2 Managing Employee Apr 4, 2022
Jennifer Michelle Mazurek Individual 5% Or Greater Direct Ownership Interest Dec 1, 2021 99%
General Partnership InterestMember Dec 21, 2021 1%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1740940790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3484 US HIGHWAY 13 S",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275301025",
            "telephone_number": "919-689-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3484 US HIGHWAY 13 S",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275301025",
            "telephone_number": "919-689-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEBELL HEALTH & WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-17",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A",
        "authorized_official_last_name": "MAZUREK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "DNP, FNP-BC",
        "authorized_official_telephone_number": "252-903-9974",
        "authorized_official_credential": "DNP, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER LICENSE NUMBER",
            "identifier": "5011760",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

Verify at the official NPI Registry.