Individual provider Active NPI

Marcus Craig Whaley, MD

  • Pediatrics Physician
  • New Bern, NC
National Provider Identifier
1124011523
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
200300105 Issued in NC
Practice address
2636 Dr Martin Luther King Jr Blvd
New Bern, NC 28562-4238
Phone
(252) 636-1919
Fax
(252) 636-2656
NPI assigned
Aug 31, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 200300105 NC Primary

Addresses

Primary practice location

2636 Dr Martin Luther King Jr Blvd
New Bern, NC 28562-4238

Mailing address

PO Box 896206
Charlotte, NC 28289-6206
Phone (252) 636-1919

Other identifiers 3

IdentifierTypeStateIssuer
136MFOtherNCBLUE CROSS
89136MFMedicaidNC
2018380COtherNCMEDICARE PTAN

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
I20040612000210 NC Practitioner - Pediatric Medicine 4385627991 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200300105NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinaeast Physicians CurrentSince Jan 1, 2011 Accepting new patients
Carolinaeast Physicians Pediatrics CurrentSince Jan 1, 2011 Accepting new patients
Carolinaeast Physicians Pediatrics Current Accepting new patients
Carolinaeast Physicians Pediatrics PastSince Aug 6, 2019 Accepting new patients
Carolinaeast Physicians Pediatrics PastSince Aug 6, 2019 Accepting new patients

Locations

532 Webb Blvd
Havelock, NC 28532
Phone (252) 447-7088

2604 Martin Luther King Jr Blvd
New Bern, NC 28562
Phone (252) 638-4023

Interoperability endpoints

  • Direct secure messaging: mwhaley19450@carolinaeastmc.direct-ci.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564444800000",
    "number": "1124011523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 896206",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282896206",
            "telephone_number": "252-636-1919",
            "fax_number": "252-636-2656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2636 DR MARTIN LUTHER KING JR BLVD",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285624238",
            "telephone_number": "252-636-1919",
            "fax_number": "252-636-2656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHALEY",
        "first_name": "MARCUS",
        "middle_name": "CRAIG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2019-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "200300105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "136MF",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89136MF",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "2018380C",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Bern, NC

Sources for this page

Verify at the official NPI Registry.