NPIMap

Organization Active NPI

Tri County Community Health Council Inc

Doing business as CommWell Health Mobile Healthcare Unit 1

  • Federally Qualified Health Center (FQHC)
  • Four Oaks, NC
National Provider Identifier
1932867199
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Doing business as
CommWell Health Mobile Healthcare Unit 1
Practice address
6114 US Highway 301 S
Four Oaks, NC 27524-7417
Phone
(877) 935-5255
Fax
(910) 236-2118
NPI assigned
Dec 6, 2021
Last updated
Mar 27, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TRI COUNTY COMMUNITY HEALTH COUNCIL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2024

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

Authorized official

Name
Wiliam C Ellison
Title
Revenue Cycle Manager
Phone
(910) 567-7065

Specialties & licenses 1

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

Addresses

Primary practice location

6114 US Highway 301 S
Four Oaks, NC 27524-7417

Mailing address

PO Box 340
Four Oaks, NC 27524-0340
Phone (910) 567-6194

Other names 1

  • CommWell Health Mobile Healthcare Unit 1 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040702000780 NC Part B Supplier - Clinic/Group Practice 2163409558 Receives reassigned benefits from 52 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Willard, NC; Tar Heel, NC; Smithfield, NC; Shallotte, NC; Dunn, NC; Salemburg, NC; Ocean Isle Beach, NC; Harrells, NC…
O20220921000155 NC Part A Provider - Federally Qualified Health Center (FQHC) 2163409558 Practice locations: Four Oaks, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932867199. Details of each certification follow.

Federally qualified health center certification: CCN 861971

Legal name
TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Doing business as
COMMWELL HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 9, 2022
Last certification
Aug 9, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 21, 1977 in NC
Enrollment address
6114 US Highway 301 S
Four Oaks, NC 27524-7417

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

National Provider Directory

National Provider Directory
Tax ID family
Carolina Oaks Family Health25 organizations share this tax ID, including this one
Part of
Carolina Oaks Family Health

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

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
Nancy J Blackman Individual Corporate DirectorBoard Member Feb 22, 2022
Phillip E Mills Individual Corporate DirectorBoard Member Feb 22, 2022
Vanessa a Burgess Individual Corporate DirectorBoard Member Feb 22, 2022
Raymond Lindsey Individual Corporate DirectorBoard Member Feb 22, 2022
Kenneth a Cabral Individual Corporate DirectorBoard Member Feb 22, 2022
Mary Crumpler Individual Corporate DirectorBoard Member Feb 22, 2022
Silvia a. Cendejas Individual Corporate DirectorBoard Member Feb 22, 2022
Gary Herring Individual Corporate DirectorBoard Member Feb 22, 2022
Spencer McAlpine Individual Corporate DirectorBoard Member Feb 22, 2022
William Taylor Individual Corporate DirectorBoard Member Feb 22, 2022
Jose Garcia Individual Corporate DirectorBoard Member Feb 22, 2022
Pamela Tripp Individual Corporate OfficerPresident/Ceo Sep 21, 2009
W-2 Managing EmployeePresident/Ceo Sep 21, 2009
Mary E Blaizes Individual Corporate DirectorBoard Member Feb 22, 2022
William C Ellison Individual Corporate OfficerRevenue Cycle Manager Feb 22, 2022

Practitioners & affiliated clinicians

Practitioners 1

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": "1638748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711497600000",
    "number": "1932867199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 340",
            "city": "FOUR OAKS",
            "state": "NC",
            "postal_code": "275240340",
            "telephone_number": "910-567-6194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6114 US HIGHWAY 301 S",
            "city": "FOUR OAKS",
            "state": "NC",
            "postal_code": "275247417",
            "telephone_number": "877-935-5255",
            "fax_number": "910-236-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI COUNTY COMMUNITY HEALTH COUNCIL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRI COUNTY COMMUNITY HEALTH COUNCIL INC",
        "enumeration_date": "2021-12-06",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A",
        "authorized_official_last_name": "ELLISON",
        "authorized_official_first_name": "WILIAM",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "910-567-7065"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CommWell Health Mobile Healthcare Unit 1",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CommWell Health Mobile Healthcare Unit 1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Four Oaks, NC

Sources for this page

Verify at the official NPI Registry.