NPIMap

Organization Active NPI

Southeastern Regional Medical Center

Doing business as SRMC IP Diabetes & Endocrinology Care

  • Nurse Practitioner
  • Lumberton, NC
National Provider Identifier
1245939651
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
SOUTHEASTERN REGIONAL MEDICAL CENTER
Doing business as
SRMC IP Diabetes & Endocrinology Care
Practice address
300 W 27TH St
Lumberton, NC 28358-3075
Phone
(910) 671-5290
Fax
(910) 671-8512
NPI assigned
Feb 24, 2023
Last updated
Feb 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

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

Authorized official

Name
Sara B Bradley
Title
VP/Cfo
Phone
(910) 671-5297

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

300 W 27TH St
Lumberton, NC 28358-3075

Mailing address

PO Box 1408
Lumberton, NC 28359-1408
Phone (910) 671-5000

Other names 1

  • SRMC IP Diabetes & Endocrinology Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000154 NC Part B Supplier - Clinic/Group Practice 7315857141 Receives reassigned benefits from 71 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lumberton, NC

Other NPIs on the same Medicare enrollment 41

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

View all 41

National Provider Directory

National Provider Directory
Tax ID family
Southeastern Reg Med Ctr36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1677196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677196800000",
    "number": "1245939651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1408",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283591408",
            "telephone_number": "910-671-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W 27TH ST",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283583075",
            "telephone_number": "910-671-5290",
            "fax_number": "910-671-8512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-24",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "910-671-5297"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SRMC IP Diabetes & Endocrinology Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lumberton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2023; 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.