Alan D Ancillotti, NP
Individual provider Active NPI Family Nurse Practitioner · Rutherfordton, NC
NPI 1972845204 · NPPES record last updated Dec 3, 2020
Key facts
- NPI
- 1972845204
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 5006142 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Black River Health Services Inc
Practice addresses (Care Compare)
301 S Campbell St
Burgaw, NC 28425-5011
Phone (910) 259-5721
Hospital & facility affiliations
- Pender Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130828001033 | NC | Practitioner - Nurse Practitioner | 3476505371 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DLP Rutherford Physician Practices LLC | Current |
Accepting new patients | |
| Black River Health Services Inc | Current | Accepting new patients | |
| Black River Health Services Inc | Family | Current | Accepting new patients |
| DLP Rutherford Physician Practices LLC | Family | Current |
Accepting new patients |
| Black River Health Services Inc | Current |
Accepting new patients | |
| Black River Health Services Inc | Current |
Accepting new patients | |
| Black River Health Services Inc | Past | Accepting new patients | |
| DLP Rutherford Physician Practices LLC | Past | Accepting new patients |
Locations
109 W Church St
Atkinson, NC 28421
Phone (910) 283-7783
301 S Campbell St
Burgaw, NC 28425
Phone (910) 259-5721
197 Plaza Dr
Forest City, NC 28043
Phone (828) 286-2083
212 Allendale Dr
Forest City, NC 28043
Phone (828) 245-3575
4811 NC Hwy 50
Maple Hill, NC 28454
Phone (910) 259-6444
288 S Ridgecrest Ave
Rutherfordton, NC 28139
Phone (252) 808-6000
128 Dr Henry Norris Dr
Rutherfordton, NC 28139
Phone (828) 286-3479
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 5006142 | NC | Yes |
Addresses
Primary practice location
128 Doctor Henry Norris Dr
Rutherfordton, NC 28139-3165
Mailing address
128 Doctor Henry Norris Dr
Rutherfordton, NC 28139-3165
Phone (828) 286-5575
Other practice location 1
197 Plaza Dr
Forest City, NC 28043-3712
Phone (828) 286-9438
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | alan.ancillotti.1@9573.direct.athenahealth.com |
Other providers in Rutherfordton, NC
- 518 Old US Highway 221 Opco LLC
- Accordius Health at Rutherford LLC
- Advanced Virtual Healthcare LLC
- William Patrick Amos
- Arc Services Inc Dba Monarch
- Arcadia Pathology Network, PLLC
- B Business Corp.
- Emily Jordan Baldwin
- Heather Leah Banfield
All providers in Rutherfordton, NC · Family Nurse Practitioner 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 Dec 3, 2020. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.