NPIMap

Organization Active NPI

Eagle Physicians and Associates PA

Doing business as Eagle Family Medicine at Village

  • Family Medicine Physician
  • Greensboro, NC
National Provider Identifier
1164595757
Registry record updated Sep 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EAGLE PHYSICIANS AND ASSOCIATES PA
Doing business as
Eagle Family Medicine at Village
Practice address
301 E Wendover Ave
Suite 215
Greensboro, NC 27401-1230
Phone
(336) 379-1156
Fax
(336) 370-0442
NPI assigned
Nov 15, 2006
Last updated
Sep 24, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
EAGLE PHYSICIANS AND ASSOCIATES PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 24, 2015

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

Authorized official

Name
Terri S. Jones
Title
Director, Eagle Business Services
Phone
(336) 268-3201

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

301 E Wendover Ave
Suite 215
Greensboro, NC 27401-1230

Mailing address

PO Box 14883
Greensboro, NC 27415-4883
Phone (336) 379-1156

Other names 1

  • Eagle Family Medicine at Village Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031120000436 NC Part B Supplier - Clinic/Group Practice 0244134468 Receives reassigned benefits from 207 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oak Ridge, NC; Greensboro, NC

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Tax ID family
Eagle Physicians and As11 organizations share this tax ID, including this one
Part of
Eagle Physicians and As

Other organizations with this tax ID 10

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443052800000",
    "number": "1164595757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14883",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274154883",
            "telephone_number": "336-379-1156",
            "fax_number": "336-370-0442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E WENDOVER AVE",
            "address_2": "SUITE 215",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011230",
            "telephone_number": "336-379-1156",
            "fax_number": "336-370-0442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE PHYSICIANS AND ASSOCIATES PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAGLE PHYSICIANS AND ASSOCIATES PA",
        "enumeration_date": "2006-11-15",
        "last_updated": "2015-09-24",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "DIRECTOR, EAGLE BUSINESS SERVICES",
        "authorized_official_telephone_number": "336-268-3201"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Family Medicine at Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2015; 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.