NPIMap

Organization Active NPI

Haywood Pediatric and Adolescent Medicine Group, P.a.

  • Pediatric Adolescent Medicine Physician
  • Clyde, NC
National Provider Identifier
1245231364
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
HAYWOOD PEDIATRIC AND ADOLESCENT MEDICINE GROUP, P.A.
Practice address
15 Facility Dr
Clyde, NC 28721-9438
Phone
(828) 452-2211
Fax
(828) 452-4421
NPI assigned
Aug 10, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Chris Henson, CMA
Title
Business Manager
Phone
(828) 452-2211

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X NU Primary

Addresses

Primary practice location

15 Facility Dr
Clyde, NC 28721-9438

Mailing address

15 Facility Dr
Clyde, NC 28721-9438
Phone (828) 452-2211

Other identifiers 2

IdentifierTypeStateIssuer
8901737MedicaidNC
01737OtherNCBCBS OF NC

Other names 1

  • Haywood Pediatrics Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160208001312 NC Part B Supplier - Clinic/Group Practice 1254635592 Receives reassigned benefits from 1 practitioner
Practice locations: Clyde, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0247598Haywood Pediatrics-Clyde15 Facility Dr, Clyde, NC 28721AccreditationAug 9, 2027

National Provider Directory

National Provider Directory

Locations

15 Facility Dr
Clyde, NC 28721
Phone (828) 452-2211

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20223/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245231364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 FACILITY DR",
            "city": "CLYDE",
            "state": "NC",
            "postal_code": "287219438",
            "telephone_number": "828-452-2211",
            "fax_number": "828-452-4421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 FACILITY DR",
            "city": "CLYDE",
            "state": "NC",
            "postal_code": "287219438",
            "telephone_number": "828-452-2211",
            "fax_number": "828-452-4421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAYWOOD PEDIATRIC AND ADOLESCENT MEDICINE GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENSON",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "828-452-2211",
        "authorized_official_credential": "CMA"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901737",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "01737",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haywood Pediatrics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Clyde, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.