NPIMap

Organization Active NPI

Albemarle Orthotics & Prosthetics, Inc

  • Customized Equipment (DME)
  • Elizabeth City, NC
National Provider Identifier
1124096292
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Legal business name
ALBEMARLE ORTHOTICS & PROSTHETICS, INC
Practice address
106 Medical Drive
Elizabeth City, NC 27909
Phone
(252) 338-3002
Fax
(252) 338-2902
NPI assigned
Mar 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

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

Authorized official

Name
Kimberly S Williamson, CPONPI 1699788372
Title
Owner
Phone
(252) 338-3002

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
Durable Medical Equipment & Medical Supplies 332B00000X
Customized Equipment (DME) 332BC3200X NC Primary
Prosthetic/Orthotic Supplier 335E00000X

Addresses

Primary practice location

106 Medical Drive
Elizabeth City, NC 27909

Mailing address

106 Medical Drive
Elizabeth City, NC 27909
Phone (252) 338-3002

Other identifiers 4

IdentifierTypeStateIssuer
384410OtherVABCBS
0482POtherNCBCBS
7701327MedicaidNC
9190511MedicaidVA

Other names 1

  • Coastal Carolina Prosthetics & Orthotics, Inc Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930054951 NC DME Supplier - Orthotic PersonnelDME Supplier - Prosthetic PersonnelDME Supplier - Medical Supply Company With Prosthetic PersonnelDME Supplier - Medical Supply Company With Orthotic PersonnelDME Supplier - Medical Supply Company With Orthotic-Prosthetic 1355460254 Practice locations: Elizabeth City, NC

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Coastal Carolina Prosthetics & Orth106 Medical Dr, Elizabeth City, NC 27909-3361(252) 338-3002 Contracture Treatment Devices: Dynamic Splint|Canes and/or Crutches|Walkers|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Albemarle Orthotics Prosthetics Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1124096292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 MEDICAL DRIVE",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "27909",
            "telephone_number": "252-338-3002",
            "fax_number": "252-338-2902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 MEDICAL DRIVE",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "27909",
            "telephone_number": "252-338-3002",
            "fax_number": "252-338-2902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBEMARLE ORTHOTICS & PROSTHETICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-338-3002",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NC",
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "384410",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0482P",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7701327",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9190511",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Carolina Prosthetics & Orthotics, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Elizabeth City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.