Rural Health Group Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Hollister, NC
NPI 1902995145 · NPPES record last updated May 27, 2008
Key facts
- NPI
- 1902995145
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- RURAL HEALTH GROUP INC
- Practice address
- 204 Evans Road
Hollister, NC 27844-0010 - Phone
- (252) 586-5151
- Fax
- (252) 586-6932
- NPI assigned
- Oct 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Brian O Harris
- Title
- Ceo
- Phone
- (252) 537-5842
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 17
Other NPIs with the same Medicare PAC ID 18
Practitioners 66
-
Erin Gillies Bristow, NP-C
-
Eilis Clark, MD
-
Rebecca Gregory Dillon, MHS, MS, RDN, PA-C
-
Auburn Hunter, PA
-
Holly Virginia Mackenna, M.D.
-
Richard Anthony Moore II, M.D.
-
Hallie Rachel Murchison, PA-C
-
Sharon Butler Pair, MSW, LCSW, LCAS
-
Jennifer Pernesky, FNP
-
Kendra Briann Pruitt, LCSW, MSW
-
Shelly Hilliard Shearin, FNP-BC
-
Karen Lee Stimson, LCSW
-
Laura Ucik, MD
-
Christina Jene Allen, PA-C
-
Joseph Antinori, M.D.
-
Susan L Baker, FNP-BC
-
Laquita Balmer, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Federally qualified health center certification: CCN 341911
- Legal name
- RURAL HEALTH GROUP INC
- Doing business as
- RURAL HEALTH GROUP AT TWIN COUNTY
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 6, 2006
- Last certification
- Dec 6, 2006
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 4, 1985 in NC
- Enrollment address
- 204 Evans Rd
Hollister, NC 27844-9247
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Chester Bruce Williams |
Corporate Director |
Mar 8, 2016 | |
| Gary Lavern Wingfield |
Corporate Director |
Aug 18, 2019 | |
| Krystian Gayle Latham |
Corporate Director |
Feb 24, 2022 | |
| Ella Green Viverette |
Corporate Director |
Dec 6, 2006 | |
| Jimille Evans Mills |
Corporate Director |
Jan 28, 2021 | |
| Patrinia Mitchell Deloatch |
W-2 Managing Employee |
Apr 22, 2024 | |
| Cynthia Lynette Brown |
Corporate Director |
Jan 1, 2007 | |
| Yvonne Long Gee |
Corporate Officer |
Jan 27, 2018 | |
| Wilhelmena Rae Herritage Mitchell |
Corporate Director |
Jan 1, 2007 | |
| Sara Myrick Council |
Corporate Director |
Mar 17, 2019 | |
| Clyde Anthony Johnston |
Corporate Director |
Jan 1, 2007 | |
| Lutricia Lynch Lewis |
Corporate Director |
Jan 1, 2007 | |
| Audrey Lee Hardy |
Corporate Director |
Mar 8, 2016 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Rural Health Group at Henderson |
Federally qualified health center | Operational/Managerial Control | Aug 31, 2009 |
| Rural Health Group at Enfield |
Federally qualified health center | Operational/Managerial Control | Jul 2, 2012 |
| Rural Health Group at Halifax Community College |
Federally qualified health center | Operational/Managerial Control | Feb 13, 2018 |
| Rural Health Group at Drugco Express |
Federally qualified health center | Operational/Managerial Control | Jul 17, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050708000124 | NC | Part B Supplier - Clinic/Group Practice | 9739090226 |
Receives reassigned benefits from 81 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Enfield, NC; Whitakers, NC; Weldon, NC; Stovall, NC; Scotland Neck, NC; Roanoke Rapids, NC; Norlina, NC; Littleton, NC… |
| O20061107000440 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 9739090226 | Practice locations: Hollister, NC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
204 Evans Road
Hollister, NC 27844-0010
Mailing address
PO Box 10
Hollister, NC 27844-0010
Phone (252) 586-5151
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 344533A | Medicaid | NC | |
| 03054 | Other | NC | BC/BS OF NORTH CAROLINA |
Other names
- Rural Health Group at Twin County
Other providers in Hollister, NC
- Haliwa Saponi Tribal School
- Kari Suzanne Light
- Jane Harvey McCaleb
- Jade Alexia Mills
- Ladonna Denise Richardson
- Rural Health Group, Inc
- Dawn Nichole Rush
- Statewide Mental Health & Disability Services, PLLC
- Twin County Rural Health Center, Inc.
All providers in Hollister, NC · Federally Qualified Health Center (FQHC) in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.