NPIMap

Organization Active NPI

Star Medical Clinic PLLC

  • General Practice Physician
  • Jacksonville, NC
National Provider Identifier
1033565007
Registry record updated Jun 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
STAR MEDICAL CLINIC PLLC
Practice address
461 Western Blvd Ste 122
Jacksonville, NC 28546-7637
Phone
(910) 333-0283
Fax
(910) 333-0513
NPI assigned
May 10, 2016
Last updated
Jun 17, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2019

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

Authorized official

Name
Mr. Kevin R ScyocNPI 1821623000
Title
Ceo
Phone
(910) 330-2335

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

461 Western Blvd Ste 122
Jacksonville, NC 28546-7637

Mailing address

461 Western Blvd Ste 122
Jacksonville, NC 28546-7637
Phone (910) 333-0283

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160919000529 NC Part B Supplier - Clinic/Group Practice 6800183963 Receives reassigned benefits from 42 practitioners
Practice locations: Jacksonville, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2117053Star Medical Clinic, PLLC461 Western Boulevard, Suite 122, Jacksonville, NC 28546Certificate of waiverAug 7, 2026

National Provider Directory

National Provider Directory

Locations

1703 Country Club Rd
#103104
Jacksonville, NC 28546

1703 Country Club Rd
Ste 103
Jacksonville, NC 28546
Phone (910) 330-2335

461 Western Blvd
Jacksonville, NC 28546

461 Western Blvd
Ste 122
Jacksonville, NC 28546
Phone (910) 333-0283

Practitioners & affiliated clinicians

Practitioners 56

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 56

NPI Registry JSON

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

{
    "created_epoch": "1462838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560729600000",
    "number": "1033565007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 WESTERN BLVD STE 122",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467637",
            "telephone_number": "910-333-0283",
            "fax_number": "910-333-0513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 WESTERN BLVD STE 122",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467637",
            "telephone_number": "910-333-0283",
            "fax_number": "910-333-0513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-10",
        "last_updated": "2019-06-17",
        "status": "A",
        "authorized_official_last_name": "SCYOC",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-330-2335",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.