NPIMap

Organization Active NPI

Van L. Adams M. D., PLLC

Doing business as Carolina Internal Medicine and Pediatrics

  • Primary Care Clinic/Center
  • Goldsboro, NC
National Provider Identifier
1124460514
Registry record updated Jul 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
VAN L. ADAMS M. D., PLLC
Doing business as
Carolina Internal Medicine and Pediatrics
Practice address
204 Malloy St Ste a
Goldsboro, NC 27534-4477
Phone
(919) 751-7665
Fax
(919) 651-1370
NPI assigned
Jul 25, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2013

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

Authorized official

Name
Dr. Van Lee Adams, M.D.NPI 1588872964
Title
Physician/Owner
Phone
(919) 751-7665

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
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

204 Malloy St Ste a
Goldsboro, NC 27534-4477

Mailing address

204 Malloy St Ste a
Goldsboro, NC 27534-4477
Phone (919) 751-7665

Other names 1

  • Carolina Internal Medicine and Pediatrics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131202000353 NC Part B Supplier - Clinic/Group Practice 4082840715 Receives reassigned benefits from 4 practitioners
Practice locations: Goldsboro, NC

National Provider Directory

National Provider Directory

Locations

204 Malloy St
#A
Goldsboro, NC 27534
Phone (919) 584-5855

Practitioners & affiliated clinicians

Practitioners 7

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": "1374710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374710400000",
    "number": "1124460514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 MALLOY ST STE A",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275344477",
            "telephone_number": "919-751-7665",
            "fax_number": "919-651-1370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MALLOY ST STE A",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275344477",
            "telephone_number": "919-751-7665",
            "fax_number": "919-651-1370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN L. ADAMS M. D., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-25",
        "last_updated": "2013-07-25",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "VAN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "919-751-7665",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Internal Medicine and Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Goldsboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2013; 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.