Active NPI
Eastern Carolina Geriatric Associates & Family Care Ctr PLLC
- Rural Health Clinic/Center
- Powellsville, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- EASTERN CAROLINA GERIATRIC ASSOCIATES & FAMILY CARE CTR PLLC
- Practice address
- 105 Commerce Street
Powellsville, NC 27967-0040 - Phone
- (252) 332-6484
- Fax
- (252) 332-1660
- NPI assigned
- May 30, 2008
- Last updated
- Dec 17, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Steven Wallace Ferguson, MD
- Title
- President
- Phone
- (252) 332-6484
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Primary |
Addresses
Primary practice location
105 Commerce Street
Powellsville, NC 27967-0040
Mailing address
105 Commerce Street
Powellsville, NC 27967-0040
Phone (252) 332-6484
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5950178 | Medicaid | NC | |
| 8931664 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 2
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1962660472. Details of each certification follow.
Rural health clinic certification: CCN 348939
- Legal name
- EASTERN CAROLINA GERIATRIC ASSOCIATES & FAMILY CARE CTR PLLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 24, 2002
- Last certification
- May 29, 2018
- Ownership / control type
- 1A
- Most recent change of ownership
- Jun 1, 2008 (1 total)
- Organization structure
- LLC
- Incorporated
- Apr 29, 2008 in NC
- Enrollment address
- 105 Commerce Street
Powellsville, NC 27962
National Provider Directory
National Provider Directory- Tax ID family
- Eastern Carolina Geriatric Associates Family Care Ctr PLLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Medicine Physician
- Powellsville, NC
- NPI 1003057696
Ownership & related parties
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Eastern Carolina Geriatric Associates & Family Care Ctr PLLC | 5% Or Greater Direct Ownership Interest | Jun 1, 2008 | 100% |
| Steven Ferguson | 5% Or Greater Direct Ownership Interest | Jun 1, 2008 | 100% |
| W-2 Managing Employee | Jun 1, 2008 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Powellsville, NC
- NPI 1295788628
5% Or Greater Direct Ownership Interest, W-2 Managing Employee
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.
-
- Family Medicine Physician
- Powellsville, NC
- NPI 1295788628
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212105600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1261008000000",
"number": "1962660472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 COMMERCE STREET",
"city": "POWELLSVILLE",
"state": "NC",
"postal_code": "279670040",
"telephone_number": "252-332-6484",
"fax_number": "252-332-1660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 COMMERCE STREET",
"city": "POWELLSVILLE",
"state": "NC",
"postal_code": "279670040",
"telephone_number": "252-332-6484",
"fax_number": "252-332-1660"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EASTERN CAROLINA GERIATRIC ASSOCIATES & FAMILY CARE CTR PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-05-30",
"last_updated": "2009-12-17",
"status": "A",
"authorized_official_last_name": "FERGUSON",
"authorized_official_first_name": "STEVEN",
"authorized_official_middle_name": "WALLACE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "252-332-6484",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5950178",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8931664",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Powellsville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2009; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.