NPIMap

Organization Active NPI

Sampson Regional Professional Services, LLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Clinton, NC
National Provider Identifier
1205259298
Registry record updated Jan 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X
Legal business name
SAMPSON REGIONAL PROFESSIONAL SERVICES, LLC
Practice address
607 Beaman St
Clinton, NC 28328-2603
Phone
(910) 590-8710
Fax
(910) 596-4309
NPI assigned
Jan 27, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2014

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

Authorized official

Name
Jennifer J Coble
Title
Dirctor of Practice Management
Phone
(910) 596-5424

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0011X Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

607 Beaman St
Clinton, NC 28328-2603

Mailing address

607 Beaman St
Clinton, NC 28328-2603
Phone (910) 596-5424

Other names 1

  • Sampson Wound Professional Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091014000771 NC Part B Supplier - Clinic/Group Practice 6406992817 Receives reassigned benefits from 33 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, NC; Roseboro, NC; Newton Grove, NC

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1390780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390780800000",
    "number": "1205259298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 BEAMAN ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282603",
            "telephone_number": "910-596-5424",
            "fax_number": "910-596-5430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 BEAMAN ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282603",
            "telephone_number": "910-590-8710",
            "fax_number": "910-596-4309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMPSON REGIONAL PROFESSIONAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-27",
        "last_updated": "2014-01-27",
        "status": "A",
        "authorized_official_last_name": "COBLE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRCTOR OF PRACTICE MANAGEMENT",
        "authorized_official_telephone_number": "910-596-5424"
    },
    "taxonomies": [
        {
            "code": "2083P0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sampson Wound Professional Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2014; 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.