NPIMap

Organization Active NPI

Black River Health Services Inc

Doing business as Atkinson Drug

  • Community/Retail Pharmacy
  • Atkinson, NC
National Provider Identifier
1215488317
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
13102 Issued in NC
Legal business name
BLACK RIVER HEALTH SERVICES INC
Doing business as
Atkinson Drug
Practice address
124 W Main St
Atkinson, NC 28421-0069
Phone
(910) 283-5400
Fax
(910) 283-7336
NPI assigned
Oct 24, 2016
Last updated
Feb 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

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

Authorized official

Name
Dr. Janice Chapman McDermott, PHARMDNPI 1306150164
Title
Pharmacist
Phone
(910) 283-5400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 13102 NC Primary

Addresses

Primary practice location

124 W Main St
Atkinson, NC 28421-0069

Mailing address

124 W Main St
Atkinson, NC 28421-0069
Phone (910) 283-5400

Other identifiers 2

IdentifierTypeStateIssuer
0715269MedicaidNC
2164625OtherPK

Other names 1

  • Atkinson Drug Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151001001556 NC Part B Supplier - Mass Immunization (Roster Biller Only) 0345131579 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atkinson, NC; Maple Hill, NC

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Black River Health Serv4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

109 W Church St
Atkinson, NC 28421
Phone (910) 283-7783

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1215488317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 W MAIN ST",
            "city": "ATKINSON",
            "state": "NC",
            "postal_code": "284210069",
            "telephone_number": "910-283-5400",
            "fax_number": "910-283-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 W MAIN ST",
            "city": "ATKINSON",
            "state": "NC",
            "postal_code": "284210069",
            "telephone_number": "910-283-5400",
            "fax_number": "910-283-7336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-24",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A",
        "authorized_official_last_name": "MCDERMOTT",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "CHAPMAN",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "910-283-5400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "13102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0715269",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2164625",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atkinson Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atkinson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; 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.