Individual provider Active NPI

Sean Carl Vidulich, DO

  • Family Medicine Physician
  • Greenville, NC
National Provider Identifier
1053767749
Registry record updated Oct 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2019-01617 Issued in NC
Practice address
1204 E Fire Tower Rd
Greenville, NC 27858-4196
Phone
(252) 744-1122
Fax
(252) 744-1133
NPI assigned
May 11, 2016
Last updated
Oct 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2019-01617 NC Primary
Family Medicine Physician 207Q00000X DR.0064081 CO

Addresses

Primary practice location

1204 E Fire Tower Rd
Greenville, NC 27858-4196

Mailing address

PO Box 751069
Charlotte, NC 28275-1069

Other identifiers 1

IdentifierTypeStateIssuer
029075OtherCOKAISER COMMERCIAL NUMBER

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address svidulich104065@direct.vidanthealth.com Health Information Exchange (HIE)
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190925002105 NC Practitioner - Family PracticePractitioner - General Practice 8921392820 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
East Carolina UniversityGroup PAC ID 0244143246, 499 clinicians
Rural Health Group IncGroup PAC ID 9739090226, 65 clinicians

Practice addresses (Care Compare)

1204 E Fire Tower Rd
Greenville, NC 27858-4196
Phone (252) 744-1122

270 Smith Church Rd
Roanoke Rapids, NC 27870-4914
Phone (252) 537-0134

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DR.0064081COMDFamily Medicine Physician
2019-01617NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rural Health Group, Inc. CurrentSince Aug 15, 2025 Accepting new patients
Rural Health Group, Inc. CurrentSince Aug 15, 2025 Accepting new patients
East Carolina University Past Accepting new patients
Rural Health Group, Inc. Past Accepting new patients

Locations

270 Smith Church Rd
Roanoke Rapids, NC 27870
Phone (252) 308-6816

Interoperability endpoints

  • Direct secure messaging: svidulich104065@direct.vidanthealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1462924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760054400000",
    "number": "1053767749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751069",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 E FIRE TOWER RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278584196",
            "telephone_number": "252-744-1122",
            "fax_number": "252-744-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDULICH",
        "first_name": "SEAN",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-11",
        "last_updated": "2025-10-10",
        "certification_date": "2025-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2019-01617",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0064081",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER COMMERCIAL NUMBER",
            "identifier": "029075",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "svidulich104065@direct.vidanthealth.com",
            "affiliation": "N",
            "endpointDescription": "ECU Physicians",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1204 E Fire Tower Rd",
            "city": "Greenville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "278584196",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "CAREQUALITY",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "16290 E Quincy Ave",
            "city": "Aurora",
            "state": "CO",
            "country_code": "US",
            "postal_code": "800151594",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.