NPIMap

Organization Active NPI

Rising Integrative Healthcare of Wilmington, PLLC

  • General Practice Physician
  • Wilmington, NC
National Provider Identifier
1033776323
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
RISING INTEGRATIVE HEALTHCARE OF WILMINGTON, PLLC
Practice address
5 Silva Terra Dr Ste 100
Wilmington, NC 28412-2373
Phone
(910) 530-3031
NPI assigned
May 22, 2019
Last updated
Jul 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Authorized official

Name
Brian M KeanNPI 1083712269
Title
Authorized Official
Phone
(910) 530-3031

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

5 Silva Terra Dr Ste 100
Wilmington, NC 28412-2373

Mailing address

504 Red Banks Rd Ste C
Greenville, NC 27858-5766
Phone (252) 321-3579

Other identifiers 1

IdentifierTypeStateIssuer
200301497OtherNCNC MEDICAL BOARD LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200416000693 NC Part B Supplier - Clinic/Group Practice 7618307596 Receives reassigned benefits from 9 practitioners
Practice locations: Wilmington, NC

National Provider Directory

National Provider Directory

Locations

504 Red Banks Rd
Ste C
Greenville, NC 27858
Phone (252) 321-3579

4421 Junction Park Dr
Ste 200
Wilmington, NC 28412
Phone (910) 530-3031

4624 Carolina BCH Rd
Wilmington, NC 28412

5 Silva Terra Dr
Ste 100
Wilmington, NC 28412
Phone (910) 523-5176

5 Silva Terra Dr
Ste 110
Wilmington, NC 28412
Phone (910) 975-1932

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1033776323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 RED BANKS RD STE C",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278585766",
            "telephone_number": "252-321-3579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 SILVA TERRA DR STE 100",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122373",
            "telephone_number": "910-530-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RISING INTEGRATIVE HEALTHCARE OF WILMINGTON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-22",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "KEAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "910-530-3031"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC MEDICAL BOARD LICENSE",
            "identifier": "200301497",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; 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.