NPIMap

Organization Active NPI

Serenity Mental and Medical Care PLLC

  • Family Nurse Practitioner
  • Aberdeen, NC
National Provider Identifier
1225504608
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
SERENITY MENTAL AND MEDICAL CARE PLLC
Practice address
430 Magnolia Square CT
Aberdeen, NC 28315-2228
Phone
(303) 625-3694
Fax
(910) 420-2428
NPI assigned
Oct 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

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

Authorized official

Name
Mr. Philip R Couch, NP-CNPI 1215380035
Title
Owner
Phone
(303) 625-3694

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

430 Magnolia Square CT
Aberdeen, NC 28315-2228

Mailing address

25 Turtle Point Rd
Pinehurst, NC 28374-9520
Phone (303) 625-3694

Other names 1

  • Philip R Couch Sole Mbr Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190613003297 NC Part B Supplier - Clinic/Group Practice 8628301231 Receives reassigned benefits from 4 practitioners
Practice locations: Aberdeen, NC

National Provider Directory

National Provider Directory

Locations

430 Magnolia Square Ct
Aberdeen, NC 28315
Phone (910) 260-7056

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540252800000",
    "number": "1225504608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 TURTLE POINT RD",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283749520",
            "telephone_number": "303-625-3694",
            "fax_number": "910-420-2428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 MAGNOLIA SQUARE CT",
            "city": "ABERDEEN",
            "state": "NC",
            "postal_code": "283152228",
            "telephone_number": "303-625-3694",
            "fax_number": "910-420-2428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY MENTAL AND MEDICAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-23",
        "last_updated": "2018-10-23",
        "status": "A",
        "authorized_official_last_name": "COUCH",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-625-3694",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Philip R Couch Sole Mbr",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aberdeen, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2018; 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.