NPIMap

Individual provider Active NPI

Rachid Idrissi, M.D.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Benson, NC
National Provider Identifier
1174696363
Registry record updated Mar 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
200700587 Issued in NC
Practice address
1 Medical Dr
Benson, NC 27504-1177
Phone
(919) 894-1740
Fax
(919) 894-2701
NPI assigned
Nov 16, 2006
Last updated
Mar 4, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 4, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 058038 GA
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 200700587 NC Primary

Addresses

Primary practice location

1 Medical Dr
Benson, NC 27504-1177

Mailing address

1 Medical Dr
Benson, NC 27504-1177
Phone (919) 894-1740

Other identifiers 1

IdentifierTypeStateIssuer
5909173MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080513000753 NC Practitioner - Physical Medicine and Rehabilitation 5597866475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

204 Medspring Dr
Suite 100
Clayton, NC 27520-9293
Phone (919) 359-8643

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.95 of 100Reported as individual
Quality
75
Improvement activities
40
Cost
76.51

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
058038GAMDPhysical Medicine & Rehabilitation Physician
200700587NCMDPain Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Spine and Pain Center, P.a. Pain Medicine CurrentSince Mar 24, 2009 Accepting new patients
Advanced Spine and Pain Center, P.a. Pain Medicine CurrentSince Mar 24, 2009 Accepting new patients
Shilo Enterprises PC PastSince Aug 1, 2017 Accepting new patients
Advanced Spine and Pain Center, Pain Medicine Past Accepting new patients
Advanced Spine and Pain Center, P.a. Pain Medicine Past Accepting new patients
Brown Orthopaedic Surgery & Sports Medicine Center, P.a. Past Accepting new patients
Physical Medicine Center Physical Medicine & Rehabilitation PastSince Feb 7, 2013 Accepting new patients

Locations

1 Medical Dr
Benson, NC 27504
Phone (919) 207-1027

204 Medspring Dr
#100
Clayton, NC 27520
Phone (919) 359-8643

3645 Cape Center Dr
Fayetteville, NC 28304
Phone (910) 339-8475

1501 Medical Center Dr
Wilmington, NC 28401
Phone (910) 444-2524

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393891200000",
    "number": "1174696363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL DR",
            "city": "BENSON",
            "state": "NC",
            "postal_code": "275041177",
            "telephone_number": "919-894-1740",
            "fax_number": "919-894-2701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL DR",
            "city": "BENSON",
            "state": "NC",
            "postal_code": "275041177",
            "telephone_number": "919-894-1740",
            "fax_number": "919-894-2701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDRISSI",
        "first_name": "RACHID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2014-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "GA",
            "license": "058038",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NC",
            "license": "200700587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5909173",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benson, NC

Sources for this page

Verify at the official NPI Registry.