NPIMap

Organization Active NPI

Senior Health and Education Partners PLLC

  • Psychiatry Physician
  • Durham, NC
National Provider Identifier
1205237245
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SENIOR HEALTH AND EDUCATION PARTNERS PLLC
Practice address
5306 NC Highway 55 Ste 105
Durham, NC 27713-7812
Phone
(919) 572-9442
Fax
(919) 363-7697
NPI assigned
Sep 9, 2014
Last updated
Dec 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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

Authorized official

Name
Dr. Carol Minnette Gibbs, M.DNPI 1174606917
Title
Ceo
Phone
(919) 572-9442

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Psychologist 103T00000X NU
Social Worker 104100000X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

5306 NC Highway 55 Ste 105
Durham, NC 27713-7812

Mailing address

5306 NC Highway 55 Ste 105
Durham, NC 27713-7812
Phone (919) 572-9442

Other identifiers 1

IdentifierTypeStateIssuer
891234HMedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150226002113 NC Part B Supplier - Clinic/Group Practice 8729304290 Receives reassigned benefits from 44 practitioners
Practice locations: Durham, NC

National Provider Directory

National Provider Directory

Locations

5306 NC Highway 55
Ste 1
Durham, NC 27713
Phone (919) 457-1517

Practitioners & affiliated clinicians

Practitioners 48

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.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1410220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1205237245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5306 NC HIGHWAY 55 STE 105",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277137812",
            "telephone_number": "919-572-9442",
            "fax_number": "919-363-7697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5306 NC HIGHWAY 55 STE 105",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277137812",
            "telephone_number": "919-572-9442",
            "fax_number": "919-363-7697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR HEALTH AND EDUCATION PARTNERS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-09",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "GIBBS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "MINNETTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-572-9442",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891234H",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; 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.