North Carolina: Ownership and Oversight
Strict CPOM (Board position + Ch. 55B). Ownership runs through G.S. 55B-14's short list of permitted combinations plus the NCMB's position that medical businesses must be owned entirely by licensees. Oversight runs through board rules with a meeting cadence instead of ratios.
Who the statute actually covers
- "Licensee" (G.S. 55B-2): a person licensed by the board regulating the profession the entity practices. PAs are licensees of the Medical Board; NPs are licensees of the Board of Nursing (jointly regulated with NCMB for practice). This board-of-licensure distinction is why a PA can solely own a medical entity but a PA and an NP cannot co-own one.
- "Ancillary services" (55B-14(a)): a professional corporation renders one professional service plus services ancillary (subordinate) to it. NCMB reads physician services as never ancillary to PA or NP services.
1. Who can own what
| Entity / Path | Who may own | Key limits |
|---|---|---|
| Physician PC / PLLC | Physicians alone or together; one professional service per entity. | G.S. 55B-14(a); Ch. 57D for PLLCs. |
| PA-owned entity | A PA may be the sole owner of a professional entity rendering medical services, or co-own with a physician (55B-14(c)(3)). | PA must maintain a supervising physician. A physician may not practice and generate revenue for the PA-owned entity (NCMB Forum 2006 ancillary analysis). |
| NP-owned entity | Nursing combinations: RN, NP, CNS-psych, CNM, CRNA (55B-14(c)(2)); or physician + NP combinations (55B-14(c)(5)). | CPA with a physician still required. Same ancillary limitation on physicians. |
| PA + NP together | Not permitted. Licensees of different boards cannot co-own a professional entity. | Adding a physician owner changes the analysis. |
| Lay / MSO | Not permitted in the professional entity; hospital and HMO exceptions exist. | NCMB disciplines licensees who aid corporate practice (Position Statement 10.1.2). |
2. Collaborative and supervisory oversight
| Role | Agreement required | Oversight mechanics | Path to independence |
|---|---|---|---|
| PA | Written supervisory arrangement with one primary supervising physician, signed, kept at every practice site (21 NCAC 32S .0212-.0213). Intent to Practice form filed with NCMB. | No numeric ratio; NCMB expects "adequate supervision." QI meetings monthly for the first 6 months of each new practice arrangement, then every 6 months, with a signed written record. | None. |
| NP | Collaborative practice agreement with a physician, jointly regulated by NCMB and the Board of Nursing (21 NCAC 36 .0810; 21 NCAC 32M). | Same cadence as PAs: monthly for first 6 months, then every 6 months, documented. CPA reviewed at least annually. | None under current law. FPA bills perennial, not passed. |
3. Primary authorities
- N.C.G.S. Ch. 55B, § 55B-14; Ch. 57D; NCMB Position Statement 10.1.2.
- NCMB Forum No. 3 (2006); NCMB Practice Ownership FAQ.
- 21 NCAC 32S .0201, .0212, .0213, .0215, .0225.
- 21 NCAC 36 .0810 and 21 NCAC 32M.
Practical read: North Carolina swaps ratios for paperwork. No supervision caps, but a signed supervisory arrangement at every site, a meeting log on the right cadence, and a physician who never crosses from supervising into producing revenue for a PA- or NP-owned entity. In diligence, ask for the meeting records first — they are the most commonly missing document.
General education, not legal advice.