NPIMap

Organization Active NPI

Longevity Clinical LTC Associates of North Carolina PLLC

  • Primary Care Nurse Practitioner
  • Salisbury, NC
National Provider Identifier
1154907855
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
LONGEVITY CLINICAL LTC ASSOCIATES OF NORTH CAROLINA PLLC
Practice address
635 Statesville Blvd
Salisbury, NC 28144-2201
Phone
(704) 633-7390
NPI assigned
Mar 23, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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

Authorized official

Name
David C Whybrew
Title
Market President, LHP Oklahoma
Phone
(918) 859-5334

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Gerontology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LG0600X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

635 Statesville Blvd
Salisbury, NC 28144-2201

Mailing address

11770 US 1 Ste 101
Palm Beach Gardens, FL 33408-3000
Phone (561) 444-0710

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210430000235 NC Part B Supplier - Clinic/Group Practice 3375952559 Receives reassigned benefits from 26 practitioners
Practice locations: Mocksville, NC; Monroe, NC; Mooresville, NC; Raeford, NC; Reidsville, NC; Salisbury, NC; Shallotte, NC; Statesville, NC…

National Provider Directory

National Provider Directory

Locations

11770 US 1
Ste 101
Palm Beach Gardens, FL 33408

11770 US Highway 1
Ste 102
Palm Beach Gardens, FL 33408

Practitioners & affiliated clinicians

Practitioners 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616457600000",
    "number": "1154907855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11770 US 1 STE 101",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334083000",
            "telephone_number": "561-444-0710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 STATESVILLE BLVD",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281442201",
            "telephone_number": "704-633-7390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY CLINICAL LTC ASSOCIATES OF NORTH CAROLINA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-23",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-18",
        "status": "A",
        "authorized_official_last_name": "WHYBREW",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MARKET PRESIDENT, LHP OKLAHOMA",
        "authorized_official_telephone_number": "918-859-5334"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; 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.