NPIMap

Organization Active NPI

Primary Health Choice, Inc.

  • Community/Behavioral Health Agency
  • Kenansville, NC
National Provider Identifier
1013269786
Registry record updated May 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PRIMARY HEALTH CHOICE, INC.
Practice address
302 North Main Street. Suite 2
Kenansville, NC 28349
Phone
(910) 296-1200
NPI assigned
Oct 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thad Davis
Title
Ceo
Phone
(910) 865-3500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

302 North Main Street. Suite 2
Kenansville, NC 28349

Mailing address

PO Box 159
Saint Pauls, NC 28384-0159

Other identifiers 2

IdentifierTypeStateIssuer
6008873MedicaidNC
5922035MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090916000431 NC Part B Supplier - Clinic/Group Practice 3173679180 Receives reassigned benefits from 4 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Winston Salem, NC; Wilson, NC; Whiteville, NC; Shelby, NC; Sanford, NC; Salisbury, NC; Rocky Mount, NC; Red Springs, NC…

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Primary Health Choice Inc36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526947200000",
    "number": "1013269786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 159",
            "city": "SAINT PAULS",
            "state": "NC",
            "postal_code": "283840159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 NORTH MAIN STREET. SUITE 2",
            "city": "KENANSVILLE",
            "state": "NC",
            "postal_code": "28349",
            "telephone_number": "910-296-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY HEALTH CHOICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-05",
        "last_updated": "2018-05-22",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "THAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-865-3500"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6008873",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5922035",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenansville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.