NPIMap

Organization Active NPI

Easter Seals Ucp North Carolina & Virginia, Inc.

  • Community/Behavioral Health Agency
  • Raleigh, NC
National Provider Identifier
1306167713
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
Practice address
5000 Falls of Neuse Rd Ste 300
Raleigh, NC 27609-5480
Phone
(919) 865-8710
Fax
(919) 256-0772
NPI assigned
Jun 21, 2010
Last updated
Oct 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Authorized official

Name
Brett Beavers
Title
Credentialing Manager
Phone
(919) 210-7661

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

5000 Falls of Neuse Rd Ste 300
Raleigh, NC 27609-5480

Mailing address

5171 Glenwood Ave
Suite 211
Raleigh, NC 27612-3266
Phone (919) 783-8898

Other practice location 1

6026 Six Forks Rd
Raleigh, NC 27609-3899
Phone (919) 865-8710

Other practice location 2

200 W 4th St
Greenville, NC 27858-1816
Phone (252) 353-8001

Other practice location 3

5171 Glenwood Ave Ste 211
Raleigh, NC 27612-3266
Phone (919) 783-8898

Other identifiers 10

IdentifierTypeStateIssuer
8300709MedicaidNC
8301523MedicaidNC
8300672MedicaidNC
8300673MedicaidNC
8300488MedicaidNC
8300746MedicaidNC
8301327MedicaidNC
8301522MedicaidNC
8300675MedicaidNC
8300676MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101105000534 NC Part B Supplier - Clinic/Group Practice 7618161407 Receives reassigned benefits from 79 practitioners
Practice locations: Raleigh, NC; Jacksonville, NC; New Bern, NC; Nags Head, NC; Mount Airy, NC; Morganton, NC; Morehead City, NC; Kinston, NC…

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1503 Wayne Memorial Dr
Ste E
Goldsboro, NC 27534
Phone (919) 440-1217

200 W 4th St
Greenville, NC 27858
Phone (252) 353-8001

Practitioners & affiliated clinicians

Practitioners 88

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.

View all 88

NPI Registry JSON

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

{
    "created_epoch": "1277078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1306167713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5171 GLENWOOD AVE",
            "address_2": "SUITE 211",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123266",
            "telephone_number": "919-783-8898",
            "fax_number": "919-782-5486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 FALLS OF NEUSE RD STE 300",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276095480",
            "telephone_number": "919-865-8710",
            "fax_number": "919-256-0772"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6026 Six Forks Rd",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276093899",
            "country_code": "US",
            "telephone_number": "919-865-8710",
            "fax_number": "919-977-9760",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278581816",
            "country_code": "US",
            "telephone_number": "252-353-8001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5171 Glenwood Ave Ste 211",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276123266",
            "country_code": "US",
            "telephone_number": "919-783-8898",
            "fax_number": "919-783-8899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-21",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "BEAVERS",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "919-210-7661"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300709",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301523",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300672",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300673",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300488",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300746",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301327",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301522",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300675",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300676",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.