NPIMap

Organization Active NPI

Integrated Care of Greater Hickory, Inc

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Hickory, NC
National Provider Identifier
1235622101
Registry record updated Jun 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X
Legal business name
INTEGRATED CARE OF GREATER HICKORY, INC
Practice address
741 5TH St SW
Hickory, NC 28602
Phone
(828) 322-5915
NPI assigned
Jun 14, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2018

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

Authorized official

Name
Mr. Douglas David Blakeman, RMA
Title
Chief Administration Officer
Phone
(828) 322-5915

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Addiction Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QA0401X
Addiction Medicine (Psychiatry & Neurology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084A0401X Primary
Community/Behavioral Health Agency 251S00000X
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

741 5TH St SW
Hickory, NC 28602

Mailing address

741 5TH St SW
Hickory, NC 28602-3230
Phone (828) 322-5915

Other identifiers 2

IdentifierTypeStateIssuer
8973845MedicaidNC
8902716MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Integrated Care of Greater Hickory Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

741 5th St SW
Hickory, NC 28602
Phone 8283225915120

NPI Registry JSON

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

{
    "created_epoch": "1528934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529020800000",
    "number": "1235622101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 5TH ST SW",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286023230",
            "telephone_number": "828-322-5915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 5TH ST SW",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "28602",
            "telephone_number": "828-322-5915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED CARE OF GREATER HICKORY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-14",
        "last_updated": "2018-06-15",
        "status": "A",
        "authorized_official_last_name": "BLAKEMAN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATION OFFICER",
        "authorized_official_telephone_number": "828-322-5915",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RMA"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8973845",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902716",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.