FAIR BLUFF MEDICAL CLINIC PLLC
NPI 1699661652
Nurse Practitioner in Fair Bluff, NC
About Fair Bluff Medical Clinic Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FAIR BLUFF MEDICAL CLINIC PLLC (NPI 1699661652) is a healthcare organization registered as a nurse practitioner in Fair Bluff, North Carolina and active in the NPI registry since June 2025. The organization holds a CLIA Waiver certificate valid through August 7, 2027 and lists Elizabeth Paige Blackwell, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
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)
Fair Bluff Medical Clinic 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 Fair Bluff Medical Clinic 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 34D2195837
Fair Bluff Medical Clinic, LLC · Fair Bluff, 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 Fair Bluff Medical Clinic PLLC's NPI number?
The NPI number for Fair Bluff Medical Clinic PLLC is 1699661652. It was assigned to this organization in the NPPES registry on June 16, 2025.
Where is Fair Bluff Medical Clinic PLLC located?
Fair Bluff Medical Clinic PLLC is located at 12291 Andrew Jackson Hwy SW, Fair Bluff, NC 28439. The listed phone number is (910) 207-2714.
What is Fair Bluff Medical Clinic PLLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.
Is Fair Bluff Medical Clinic PLLC enrolled in Medicare?
Yes. Fair Bluff Medical Clinic PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Fair Bluff Medical Clinic PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Fair Bluff Medical Clinic 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 Fair Bluff Medical Clinic PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 34D2195837) is associated with this NPI, valid through August 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Fair Bluff Medical Clinic PLLC accept?
Health plans from Blue Cross and Blue Shield of NC list Fair Bluff Medical Clinic 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 Fair Bluff Medical Clinic PLLC was last updated on October 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 days 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.
# Fair Bluff Medical Clinic Pllc · NPI 1699661652
Nurse Practitioner organization in Fair Bluff, North Carolina. Organization record, active in the CMS NPPES registry since June 16, 2025.
## Identity
- **NPI:** 1699661652 (Entity type: Organization)
- **Enumerated:** June 16, 2025
- **Primary specialty:** Nurse Practitioner · taxonomy 363L00000X
- **Organization subpart:** No
- **Authorized official:** Elizabeth Blackwell, OWNER
## Practice location
- **Address:** 12291 ANDREW JACKSON HWY SW, Fair Bluff, NC 28439-9597
- **Phone:** (910) 207-2714
## 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:** October 22, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1699661652) · Data from the CMS NPPES public registry.