NPIMap

Organization Active NPI

Bladen Healthcare LLC

Doing business as Phillips Internal Medicine

  • Internal Medicine Physician
  • Elizabethtown, NC
National Provider Identifier
1154436012
Registry record updated Jan 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
15560 Issued in NC
Legal business name
BLADEN HEALTHCARE LLC
Doing business as
Phillips Internal Medicine
Practice address
507 Doctor's Drive
Elizabethtown, NC 28337
Phone
(910) 862-3212
Fax
(910) 862-2263
NPI assigned
Aug 20, 2006
Last updated
Jan 13, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
BLADEN HEALTHCARE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2010

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

Authorized official

Name
Mr. Ayub Ibrahim Jr.
Title
Reimbursement Director
Phone
(910) 615-6994

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 15560 NC Primary

Addresses

Primary practice location

507 Doctor's Drive
Elizabethtown, NC 28337

Mailing address

PO Box 398
Elizabethtown, NC 28337-0398
Phone (910) 862-3212

Other identifiers 1

IdentifierTypeStateIssuer
8967555MedicaidNC

Other names 1

  • Phillips Internal Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080617000314 NC Part B Supplier - Clinic/Group Practice 6800967969 Receives reassigned benefits from 173 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elizabethtown, NC; Whiteville, NC; Lumberton, NC; Dublin, NC; Clarkton, NC; Bladenboro, NC

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Part of
Bladen Healthcare LLC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263340800000",
    "number": "1154436012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 398",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283370398",
            "telephone_number": "910-862-3212",
            "fax_number": "910-862-2263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 DOCTOR'S DRIVE",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "28337",
            "telephone_number": "910-862-3212",
            "fax_number": "910-862-2263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLADEN HEALTHCARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLADEN HEALTHCARE LLC",
        "enumeration_date": "2006-08-20",
        "last_updated": "2010-01-13",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "AYUB",
        "authorized_official_title_or_position": "REIMBURSEMENT DIRECTOR",
        "authorized_official_telephone_number": "910-615-6994",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "15560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8967555",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phillips Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elizabethtown, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2010; 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.