BLACK RIVER FAMILY PRACTICE
NPI 1093703886
Clinic/Center - Federally Qualified Health Center (FQHC) in Burgaw, NC
About Black River Family Practice NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BLACK RIVER FAMILY PRACTICE (NPI 1093703886) is a healthcare organization registered as a federally qualified health center (fqhc) in Burgaw, North Carolina and active in the NPI registry since October 2005. The organization holds a CLIA Microscopy certificate valid through March 7, 2027 and lists Lee Ann Amann, Administrator, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 4
Other Names 1
Other Identifiers 2
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Black River Family Practice is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
18Medicare enrollment records show 18 clinicians reassign Medicare billing to Black River Family Practice, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians by Medicare Specialty 4
Clinicians, nearest first (18)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate for Provider-Performed Microscopy Procedures (PPMP) 34D0245905
Black River Health Services Inc · Burgaw, NCFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Black River Health Services Inc's NPI number?
The NPI number for Black River Health Services Inc is 1093703886. It was assigned to this organization in the NPPES registry on October 6, 2005. The provider is doing business as Black River Family Practice.
Where is Black River Health Services Inc located?
Black River Health Services Inc is located at 301 S Campbell St, Burgaw, NC 28425. The listed phone number is (910) 259-5721.
What is Black River Health Services Inc's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.
Is Black River Health Services Inc enrolled in Medicare?
Yes. Black River Health Services Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Black River Health Services Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 18 clinicians in 4 Medicare specialties reassign their Medicare billing to Black River Health Services Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (11), Family Practice (5) and Clinical Social Worker (1). Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Black River Health Services Inc hold a CLIA laboratory certificate?
Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 34D0245905) is associated with this NPI, valid through March 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Black River Health Services Inc accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and AmeriHealth Caritas Next and 2 other insurers list Black River Health Services Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Black River Health Services Inc was last updated on December 12, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Black River Family Practice · NPI 1093703886
Federally Qualified Health Center (FQHC) organization in Burgaw, North Carolina. Organization record, active in the CMS NPPES registry since October 6, 2005.
## Identity
- **NPI:** 1093703886 (Entity type: Organization)
- **Enumerated:** October 6, 2005
- **Primary specialty:** Clinic/Center - Federally Qualified Health Center (FQHC) · taxonomy 261QF0400X
- **Legal business name:** Black River Health Services Inc
- **Organization subpart:** No
- **Authorized official:** Lee Ann Amann, ADMINISTRATOR
## Practice location
- **Address:** 301 S CAMPBELL ST, Burgaw, NC 28425-5011
- **Phone:** (910) 259-5721 · **Fax:** (910) 259-8002
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 18 clinicians in 4 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (11), Family Practice (5), Clinical Social Worker (1); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 12, 2019
- **Other identifiers:** Medicaid 343905AC (NC); Other 0104X
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1093703886) · Data from the CMS NPPES public registry.