NPIMap

Organization Active NPI

Innovative Behavioral Health Services P.C.

  • Multi-Specialty Clinic/Center
  • Creedmoor, NC
National Provider Identifier
1124367347
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
INNOVATIVE BEHAVIORAL HEALTH SERVICES P.C.
Practice address
402 Main St
Creedmoor, NC 27522
Phone
(919) 529-2474
NPI assigned
Feb 7, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Authorized official

Name
Benjamin Joseph Mastridge, MSN, PMHNP-BCNPI 1942421508
Title
President
Phone
(919) 529-2474

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Multi-Specialty Clinic/Center 261QM1300X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

402 Main St
Creedmoor, NC 27522

Mailing address

PO Box 400
Creedmoor, NC 27522-0400
Phone (919) 529-2474

Other practice location 1

1616 Evans Rd Ste 203
Cary, NC 27513-9653
Phone (919) 234-1321

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130913000814 NC Part B Supplier - Clinic/Group Practice 5799929675 Receives reassigned benefits from 10 practitioners
Practice locations: Creedmoor, NC

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2081696Innovative Behavioral Health Services, PC402 North Main Street, Creedmoor, NC 27522Certificate of waiverMay 9, 2027

National Provider Directory

National Provider Directory

Locations

402 N Main St
Creedmoor, NC 27522
Phone (919) 529-2474

Practitioners & affiliated clinicians

Practitioners 11

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": "1360195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1124367347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "CREEDMOOR",
            "state": "NC",
            "postal_code": "275220400",
            "telephone_number": "919-529-2474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 MAIN ST",
            "city": "CREEDMOOR",
            "state": "NC",
            "postal_code": "27522",
            "telephone_number": "919-529-2474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1616 Evans Rd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Cary",
            "state": "NC",
            "postal_code": "275139653",
            "country_code": "US",
            "telephone_number": "919-234-1321",
            "fax_number": "919-234-1327",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INNOVATIVE BEHAVIORAL HEALTH SERVICES P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-07",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A",
        "authorized_official_last_name": "MASTRIDGE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-529-2474",
        "authorized_official_credential": "MSN, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Creedmoor, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; 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.