NPIMap

Organization Active NPI

Mt. Olive Chiropractic Clinic, P.C.

  • Chiropractor
  • Mount Olive, NC
National Provider Identifier
1285730697
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2404 Issued in NC
Legal business name
MT. OLIVE CHIROPRACTIC CLINIC, P.C.
Practice address
515 W Main St
Mount Olive, NC 28365-1903
Phone
(919) 658-0003
Fax
(919) 658-0310
NPI assigned
Sep 15, 2006
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
Dr. Massoud Motamed, D.C., F.A.S.A.NPI 1538238696
Title
President, D.C.
Phone
(919) 658-0003

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
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2404 NC Primary

Addresses

Primary practice location

515 W Main St
Mount Olive, NC 28365-1903

Mailing address

515 W Main St
Mount Olive, NC 28365-1903
Phone (919) 658-0003

Other identifiers 3

IdentifierTypeStateIssuer
0820MOtherNCBLUE CROSS
0820MOtherNCBLUE SHIELD
890820MMedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070810000360 NC Part B Supplier - Clinic/Group Practice 3072604628 Receives reassigned benefits from 3 practitioners
Practice locations: Mount Olive, NC

National Provider Directory

National Provider Directory

Locations

515 W Main St
Mount Olive, NC 28365
Phone (919) 658-0003

Practitioners & affiliated clinicians

Practitioners 4

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": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285730697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 W MAIN ST",
            "city": "MOUNT OLIVE",
            "state": "NC",
            "postal_code": "283651903",
            "telephone_number": "919-658-0003",
            "fax_number": "919-658-0310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 W MAIN ST",
            "city": "MOUNT OLIVE",
            "state": "NC",
            "postal_code": "283651903",
            "telephone_number": "919-658-0003",
            "fax_number": "919-658-0310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. OLIVE CHIROPRACTIC CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOTAMED",
        "authorized_official_first_name": "MASSOUD",
        "authorized_official_title_or_position": "PRESIDENT, D.C.",
        "authorized_official_telephone_number": "919-658-0003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C., F.A.S.A."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "2404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0820M",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0820M",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890820M",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Olive, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.