NPIMap

Organization Active NPI

Granville Health System

Doing business as Granville Internal Medicine & Geriatrics

  • Rural Health Clinic/Center
  • Oxford, NC
National Provider Identifier
1811999055
Registry record updated Jul 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRANVILLE HEALTH SYSTEM
Doing business as
Granville Internal Medicine & Geriatrics
Practice address
110 Professional Park Drive
Oxford, NC 27565-2756
Phone
(919) 693-6541
Fax
(919) 693-7396
NPI assigned
Jun 1, 2005
Last updated
Jul 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2026

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

Authorized official

Name
Melanie Hobgood
Title
Acting Ceo
Phone
(919) 690-3445

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NC Primary

Addresses

Primary practice location

110 Professional Park Drive
Oxford, NC 27565-2756

Mailing address

PO Box 986
Oxford, NC 27565-0986
Phone (919) 693-6541

Other identifiers 4

IdentifierTypeStateIssuer
022FTOtherNCBCBS
344646CMedicaidNC
014WAOtherNCBCBS
344646AMedicaidNC

Other names 1

  • Granville Internal Medicine & Geriatrics Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040312001033 NC Part B Supplier - Clinic/Group Practice 1052223757 Receives reassigned benefits from 125 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oxford, NC; Creedmoor, NC
O20100304000720 NC Part A Provider - Rural Health Clinic 1052223757 Practice locations: Oxford, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811999055. Details of each certification follow.

Rural health clinic certification: CCN 343437

Legal name
GRANVILLE HEALTH SYSTEM
Doing business as
GRANVILLE INTERNAL MEDICINE AND GERIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 6, 2009
Last certification
Nov 12, 2020
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
110 Professional Park
Oxford, NC 27565-2576
Related CCNs
340127

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 7

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
34D0240090Granville Internal Medicine & Geriatrics110 Professional Park Drive, Oxford, NC 27565Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Granville Health System Organization, Oxford, NC 5% Or Greater Direct Ownership Interest Aug 1, 2009 100%
Operational/Managerial Control Aug 1, 2009 100%
Robert Wheeler Individual OtherTrustee/Board Member Jan 1, 2022
James Lumpkins Individual Corporate DirectorBoard Member Jan 1, 2021
David Smith Individual OtherBoard of Trustees Jan 1, 2017
Dawn Marie Scott Omokunde Individual OtherBoard of Trustees Jan 1, 2018
Annmarie Holtzman-Wheeler Individual Corporate OfficerCno Oct 1, 2018
Corporate DirectorCno Oct 1, 2018
W-2 Managing EmployeeCno Oct 1, 2018
Jamie Purvis Individual Corporate DirectorDirector Feb 1, 2023
Joseph C Zola Individual OtherTrustee/Chief of Staff Jan 1, 2022
Tony Cozart Individual OtherTrustee Aug 1, 2009
Adam W McConnell Individual Corporate OfficerCfo, Board Member Oct 1, 2018
Corporate DirectorCfo, Board Member Oct 1, 2018
W-2 Managing Employee Oct 1, 2018
Zelodis Jay Individual OtherTrustee Aug 1, 2009
Timothy Karan Individual OtherBoard of Trustees Jan 1, 2017
Jim Cyril Blaine Individual Corporate DirectorBoard Member Jan 1, 2021
James Wiley Gooch Individual Corporate DirectorBoard Member Jan 1, 2021

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
South Granville Primary CareCreedmoor, NC, CCN 343436 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2008
Jul 1, 2008

Owned or controlled facilities with NPI records 1

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

  • Granville Health System

    dba South Granville Primary Care

    • Rural Health Clinic/Center
    • Creedmoor, NC
    • NPI 1265430854

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783468800000",
    "number": "1811999055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 986",
            "city": "OXFORD",
            "state": "NC",
            "postal_code": "275650986",
            "telephone_number": "919-693-6541",
            "fax_number": "919-693-7396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PROFESSIONAL PARK DRIVE",
            "city": "OXFORD",
            "state": "NC",
            "postal_code": "275652756",
            "telephone_number": "919-693-6541",
            "fax_number": "919-693-7396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANVILLE HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A",
        "authorized_official_last_name": "HOBGOOD",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "ACTING CEO",
        "authorized_official_telephone_number": "919-690-3445"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "022FT",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344646C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "014WA",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344646A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Granville Internal Medicine & Geriatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Granville Internal Medicine & Geriatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oxford, NC

Sources for this page

Verify at the official NPI Registry.