NPIMap

Organization Active NPI

Opportunities Industrialization Center, Inc.

Doing business as OIC Family Medical Center at Community Health Plaza

  • Federally Qualified Health Center (FQHC)
  • Rocky Mount, NC
National Provider Identifier
1750734307
Registry record updated Dec 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OPPORTUNITIES INDUSTRIALIZATION CENTER, INC.
Doing business as
OIC Family Medical Center at Community Health Plaza
Practice address
1041 Noell LN
Medical Plaza B
Rocky Mount, NC 27804-2058
Phone
(252) 962-3450
Fax
(252) 962-3451
NPI assigned
Jul 19, 2016
Last updated
Dec 13, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
OPPORTUNITIES INDUSTRIALIZATION CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 2016

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

Authorized official

Name
Mr. Reuben Blackwell
Title
Chief Executive Officer
Phone
(252) 212-3480

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NC Primary

Addresses

Primary practice location

1041 Noell LN
Medical Plaza B
Rocky Mount, NC 27804-2058

Mailing address

PO Box 2723
Rocky Mount, NC 27802-2723
Phone (252) 962-3450

Other names 1

  • OIC Family Medical Center at Community Health Plaza Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170224000627 NC Part A Provider - Federally Qualified Health Center (FQHC) 3173563590 Practice locations: Rocky Mount, NC
O20170629002020 NC Part B Supplier - Clinic/Group Practice 3173563590 Receives reassigned benefits from 11 practitioners
Practice locations: Rocky Mount, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750734307. Details of each certification follow.

Federally qualified health center certification: CCN 341059

Legal name
OPPORTUNITIES INDUSTRIALIZATION CENTER, INC
Doing business as
OIC FAMILY MEDICAL CENTER AT COMMUNITY HEALTH PLAZA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 24, 2017
Last certification
Feb 24, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 19, 1969 in NC
Enrollment address
1041 Noell Lane
Medical Plaza B
Rocky Mount, NC 27804-2058

Other NPIs with the same Medicare PAC ID 5

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

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
34D2119674Oic Family Medical Center at1041 Noell Lane Plaza B, Rocky Mount, NC 27804Certificate of waiverOct 2, 2026

National Provider Directory

National Provider Directory
Part of
Opportunities Industrialization Center Inc

Locations

1041 Noell Ln
#B
Rocky Mount, NC 27804
Phone (252) 962-3450

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Brenda F Cutchin Individual Corporate Director Jul 1, 2013
Shirley Monk-Jones Individual W-2 Managing Employee Dec 1, 2011
Chayan Tiwari Individual Operational/Managerial Control Apr 1, 2023
Reuben Blackwell Individual Corporate OfficerCeo Apr 1, 1998
Opportunities Industrialization Center, Inc Organization, Rocky Mount, NC Non-profit Operational/Managerial Control Jan 14, 2005
Sherri Bryant Individual Operational/Managerial Control Apr 1, 2023
Samuel Dickens Individual Corporate OfficerCoo Jan 1, 2009
Mary Johnson Mann Individual Corporate Director Jan 1, 2002
Donna Johnson Individual Corporate DirectorTreasurer Jan 1, 1985
Hubert D Pope Individual Corporate Director Jan 1, 2011
Andre Knight Individual Corporate Director Jan 1, 2000
Doris K Thorne Individual Corporate Director Jan 1, 2011
Evelyn Wilson Individual Corporate DirectorSecretary Jan 1, 1980
Leonard Tillery Individual Corporate Director Jul 1, 2013
Brian Ellerby Individual W-2 Managing EmployeeDirector Jun 1, 2015

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Oic Family Medical Center at Happy HillRocky Mount, NC, CCN 341023 Federally qualified health center Operational/Managerial Control Jan 14, 2005
Oic Family Medical Center Guardian CourtRocky Mount, NC, CCN 341045 Federally qualified health center Operational/Managerial Control Jan 14, 2005
Oic Specialty Care CenterRocky Mount, NC, CCN 341096 Federally qualified health center Operational/Managerial Control Mar 3, 2008
Oic Sunset AvenueRocky Mount, NC, CCN B61010 Federally qualified health center Operational/Managerial Control Jun 28, 2022

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1468886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481587200000",
    "number": "1750734307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2723",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278022723",
            "telephone_number": "252-962-3450",
            "fax_number": "252-962-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 NOELL LN",
            "address_2": "MEDICAL PLAZA B",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278042058",
            "telephone_number": "252-962-3450",
            "fax_number": "252-962-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPPORTUNITIES INDUSTRIALIZATION CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPPORTUNITIES INDUSTRIALIZATION CENTER, INC.",
        "enumeration_date": "2016-07-19",
        "last_updated": "2016-12-13",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "REUBEN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "252-212-3480",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OIC Family Medical Center at Community Health Plaza",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rocky Mount, NC

Sources for this page

Verify at the official NPI Registry.