Alan D Ancillotti, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5006142 Issued in NC

Practice address

128 Doctor Henry Norris Dr
Rutherfordton, NC 28139-3165

Phone

(828) 286-5575

Fax

(828) 286-5574

NPI assigned

Mar 25, 2013

Last updated

Dec 3, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Black River Health Services IncGroup PAC ID 0345131579, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pender Memorial Hospital Hospital, Burgaw, NC, CCN 341307

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alan.ancillotti.1@9573.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Black River Health Services Inc

  dba Black River Health Center

  • Federally Qualified Health Center (FQHC)
  • Atkinson, NC
  • NPI 1174511976

  Family

  Medicare reassignment Care Compare group NPD
• DLP Rutherford Physician Practices LLC

  • Family Medicine Physician
  • Forest City, NC
  • NPI 1962821322
  Medicare reassignment NPD
• Black River Health Services Inc

  dba Black River Family Practice

  • Federally Qualified Health Center (FQHC)
  • Burgaw, NC
  • NPI 1093703886
  NPD
• Black River Health Services Inc

  dba Atkinson Drug

  • Community/Retail Pharmacy
  • Atkinson, NC
  • NPI 1215488317
  NPD
• Black River Health Services Inc

  dba Maple Hill Medical Center

  • Federally Qualified Health Center (FQHC)
  • Maple Hill, NC
  • NPI 1356339154
  NPD
• DLP Rutherford Physician Practices LLC

  dba Rutherford Family Care

  • Rural Health Clinic/Center
  • Rutherfordton, NC
  • NPI 1720849391
  NPD
• Black River Health Services Inc

  dba Maple Hill Pharmacy

  • Community/Retail Pharmacy
  • Maple Hill, NC
  • NPI 1851388219
  NPD (past)
• DLP Rutherford Physician Practices LLC

  dba Rutherford Orthopaedics

  • Orthopaedic Surgery Physician
  • Rutherfordton, NC
  • NPI 1275943698
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pender Memorial Hospital, Incorporated

  dba Novant Health Pender Medical Center

  • Critical Access Hospital
  • Burgaw, NC
  • NPI 1295703130
  Care Compare affiliation
• Pender Memorial Hospital, Incorporated

  dba Novant Health Pender Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Burgaw, NC
  • NPI 1780653865
  Care Compare affiliation

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

{
    "created_epoch": "1364169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1972845204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 DOCTOR HENRY NORRIS DR",
            "city": "RUTHERFORDTON",
            "state": "NC",
            "postal_code": "281393165",
            "telephone_number": "828-286-5575",
            "fax_number": "828-286-5574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 DOCTOR HENRY NORRIS DR",
            "city": "RUTHERFORDTON",
            "state": "NC",
            "postal_code": "281393165",
            "telephone_number": "828-286-5575",
            "fax_number": "828-286-5574"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "197 Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Forest City",
            "state": "NC",
            "postal_code": "280433712",
            "country_code": "US",
            "telephone_number": "828-286-9438",
            "fax_number": "828-286-9935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANCILLOTTI",
        "first_name": "ALAN",
        "middle_name": "D",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-25",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5006142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alan.ancillotti.1@9573.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "128 Doctor Henry Norris Dr",
            "city": "Rutherfordton",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281393165",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• 518 Old US Highway 221 Opco LLC (Oak Grove Healthcare)
• Accordius Health at Rutherford LLC (Hilltop Health and Rehabilitation)
• William Patrick Amos
• Arc Services Inc Dba Monarch
• Arcadia Pathology Network, PLLC
• B Business Corp. (Golden Years)
• Emily Jordan Baldwin, FNP
• Heather Leah Banfield, LCMHCA

• Family Nurse Practitioner in Rutherfordton, NC
• Providers in Rutherfordton, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.