VICTORY MEDICAL PLLC
NPI 1356917793
Nurse Practitioner - Primary Care in Bladenboro, NC
About Victory Medical Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
VICTORY MEDICAL PLLC (NPI 1356917793) is a healthcare organization registered as a primary care in Bladenboro, North Carolina and active in the NPI registry since May 2021. The organization holds a CLIA Waiver certificate valid through July 13, 2027 and lists Daphne Russ Green, Fnp/owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
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)
Victory Medical Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Victory Medical PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 of Waiver 34D2229593
Victory Medical, PLLC · Bladenboro, 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 Victory Medical PLLC's NPI number?
The NPI number for Victory Medical PLLC is 1356917793. It was assigned to this organization in the NPPES registry on May 27, 2021.
Where is Victory Medical PLLC located?
Victory Medical PLLC is located at 305 South Main Street, Bladenboro, NC 28320. The listed phone number is (910) 809-0082.
What is Victory Medical PLLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.
Is Victory Medical PLLC enrolled in Medicare?
Yes. Victory Medical PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Victory Medical PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Victory Medical PLLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Victory Medical PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 34D2229593) is associated with this NPI, valid through July 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Victory Medical PLLC accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina and Ambetter of Tennessee list Victory Medical PLLC 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 Victory Medical PLLC was last updated on August 11, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Victory Medical Pllc · NPI 1356917793
Primary Care organization in Bladenboro, North Carolina. Organization record, active in the CMS NPPES registry since May 27, 2021.
## Identity
- **NPI:** 1356917793 (Entity type: Organization)
- **Enumerated:** May 27, 2021
- **Primary specialty:** Nurse Practitioner - Primary Care · taxonomy 363LP2300X
- **Organization subpart:** No
- **Authorized official:** Daphne Green, FNP/OWNER
## Practice location
- **Address:** 305 SOUTH MAIN STREET, Bladenboro, NC 28320
- **Phone:** (910) 809-0082
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 11, 2021
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1356917793) · Data from the CMS NPPES public registry.