Chadbourn Family Practice Center PA

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

CHADBOURN FAMILY PRACTICE CENTER PA

Practice address

104 E 7TH Ave
Chadbourn, NC 28431-1402

Phone

(910) 654-3143

Fax

(910) 654-4144

NPI assigned

Mar 17, 2006

Last updated

Sep 6, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dollie Elkins

Title

Practice Manager

Phone

(910) 654-3143

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780643999. Details of each certification follow.

• CCN 343918 Rural health clinic · Active · Details

Rural health clinic certification: CCN 343918

Legal name

CHADBOURN FAMILY PRACTICE CENTER PA

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jan 15, 1992

Last certification

Nov 12, 2020

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Nov 2, 1992 in NC

Enrollment address

104 E 7TH Avenue
Chadbourn, NC 28431-1402

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

Owners & managing parties with NPI records 1

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

• Michael Fitch, M.D.

  • Family Medicine Physician
  • Chadbourn, NC
  • NPI 1366462889

  5% Or Greater Direct Ownership Interest

  CMS ownership

Practitioners 4

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.

• Elizabeth Paige Barnhill-Blackwell, FNP-C

  • Family Nurse Practitioner
  • Fair Bluff, NC
  • NPI 1386275006

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Kassie J Simmons, FNP-C

  • Primary Care Nurse Practitioner
  • Chadbourn, NC
  • NPI 1013542315
  Medicare reassignment Care Compare group NPD
• Michael Fitch, M.D.

  • Family Medicine Physician
  • Chadbourn, NC
  • NPI 1366462889
  Medicare reassignment NPD
• Teresa Wright, FNP-C

  • Family Nurse Practitioner
  • Calabash, NC
  • NPI 1013564798

  Family Medicine

  Medicare reassignment NPD

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1780643999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 E 7TH AVE",
            "city": "CHADBOURN",
            "state": "NC",
            "postal_code": "284311402",
            "telephone_number": "910-654-3143",
            "fax_number": "910-654-4144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E 7TH AVE",
            "city": "CHADBOURN",
            "state": "NC",
            "postal_code": "284311402",
            "telephone_number": "910-654-3143",
            "fax_number": "910-654-4144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHADBOURN FAMILY PRACTICE CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-17",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "ELKINS",
        "authorized_official_first_name": "DOLLIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "910-654-3143"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_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
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "343918C",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "343918A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John D. Beaver, NP
• Charles Michael Beers Sr., PA
• Michael Shawn Brown, LPC
• Bobbi N Canady, RN
• Carolina Medical Center, PA
• Chadbourn Volunteer Fire Dept & Rescue
• Columbus Family Chiropractic Center PC
• Columbus Transport Inc
• Coming Together Inc.
• Community Innovations Inc

• Rural Health Clinic/Center in Chadbourn, NC
• Providers in Chadbourn, NC by specialty
• Rural Health Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.