NPIMap

Organization Active NPI

Pace Health Network, LLC

  • Psychiatry Physician
  • Whiteville, NC
National Provider Identifier
1063960904
Registry record updated Mar 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
22177049 Issued in NC
Legal business name
PACE HEALTH NETWORK, LLC
Practice address
103 Mill Pond Rd
Whiteville, NC 28472-8675
Phone
(910) 840-2154
NPI assigned
Sep 21, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2023

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

Authorized official

Name
Mrs. Amanda Wilkins, LCMHCNPI 1396971396
Title
Agency Manager
Phone
(910) 475-8333

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 22177049 NC Primary

Addresses

Primary practice location

103 Mill Pond Rd
Whiteville, NC 28472-8675

Mailing address

PO Box 2221
Whiteville, NC 28472-7221
Phone (910) 840-2154

Other identifiers 1

IdentifierTypeStateIssuer
891040UMedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161208000656 NC Part B Supplier - Clinic/Group Practice 2567742513 Receives reassigned benefits from 13 practitioners
Practice locations: Bladenboro, NC; Winnabow, NC; Wilmington, NC; Whiteville, NC; Rockingham, NC; Raeford, NC; Lumberton, NC; Laurinburg, NC…

National Provider Directory

National Provider Directory

Locations

103 Mill Pond Rd
Whiteville, NC 28472
Phone (910) 518-0432

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680220800000",
    "number": "1063960904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2221",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284727221",
            "telephone_number": "910-840-2154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 MILL POND RD",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284728675",
            "telephone_number": "910-840-2154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACE HEALTH NETWORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-21",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A",
        "authorized_official_last_name": "WILKINS",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "AGENCY MANAGER",
        "authorized_official_telephone_number": "910-475-8333",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCMHC"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "22177049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891040U",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whiteville, NC

Sources for this page

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