NPIMap

Organization Active NPI

Roanoke Valley Health Services Inc

  • Cardiovascular Disease Physician
  • Roanoke Rapids, NC
National Provider Identifier
1114110889
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
ROANOKE VALLEY HEALTH SERVICES INC
Practice address
250 Smith Church Rd
Roanoke Rapids, NC 27870-4914
Phone
(252) 672-7732
Fax
(252) 635-6951
NPI assigned
Aug 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Sherry E Jensen
Title
VP Finance - Managing Employee
Phone
(252) 535-8005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

250 Smith Church Rd
Roanoke Rapids, NC 27870-4914

Mailing address

3120 Wellons Blvd
PO Box 15409
New Bern, NC 28562-5247
Phone (252) 672-7732

Other identifiers 2

IdentifierTypeStateIssuer
020C2OtherNCNC BLUE CROSS BLUE SHIELD
5908753MedicaidNC

Other names 1

  • Roanoke Valley Cardiac & Vascular Disease Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050119001033 NC Part B Supplier - Clinic/Group Practice 4587573159 Receives reassigned benefits from 9 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenville, NC; Knightdale, NC; Roanoke Rapids, NC

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory

Locations

3120 Wellons Blvd
New Bern, NC 28562

NPI Registry JSON

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

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1114110889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 WELLONS BLVD",
            "address_2": "PO BOX 15409",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285625247",
            "telephone_number": "252-672-7732",
            "fax_number": "252-635-6951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 SMITH CHURCH RD",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278704914",
            "telephone_number": "252-672-7732",
            "fax_number": "252-635-6951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROANOKE VALLEY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-24",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "VP FINANCE - MANAGING EMPLOYEE",
        "authorized_official_telephone_number": "252-535-8005"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC BLUE CROSS BLUE SHIELD",
            "identifier": "020C2",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5908753",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roanoke Valley Cardiac & Vascular Disease Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke Rapids, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.