NPIMap

Organization Active NPI

Active Foot and Ankle of Carolina PLLC

  • Durable Medical Equipment & Medical Supplies
  • Elizabeth City, NC
National Provider Identifier
1306290648
Registry record updated Apr 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
623 Issued in NC
Legal business name
ACTIVE FOOT AND ANKLE OF CAROLINA PLLC
Practice address
1076 US Highway 17 S
Elizabeth City, NC 27909-7627
Phone
(252) 333-3111
Fax
(252) 333-1105
NPI assigned
Apr 22, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2019

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

Authorized official

Name
Dr. Munjed Salem, DPMNPI 1558681197
Title
Owner
Phone
(252) 333-3111

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 623 NC Primary
Prosthetic/Orthotic Supplier 335E00000X 623 NC

Addresses

Primary practice location

1076 US Highway 17 S
Elizabeth City, NC 27909-7627

Mailing address

632 Cedar Rd Ste B
Chesapeake, VA 23322-8376
Phone (757) 547-0123

Other practice location 1

905 Halstead Blvd
Ste 13
Elizabeth City, NC 27909-6986
Phone (252) 333-3111

Other identifiers 1

IdentifierTypeStateIssuer
1558681197MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161215001497 NC DME Supplier - Physician - Podiatry 0446568851 Practice locations: Elizabeth City, NC

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Active Foot and Ankle of Carolina PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

905 Halstead Blvd
Ste 13
Elizabeth City, NC 27909
Phone (252) 333-3111

Practitioners & affiliated clinicians

Practitioners 3

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": "1461283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555545600000",
    "number": "1306290648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 CEDAR RD STE B",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233228376",
            "telephone_number": "757-547-0123",
            "fax_number": "757-547-2412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1076 US HIGHWAY 17 S",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279097627",
            "telephone_number": "252-333-3111",
            "fax_number": "252-333-1105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "905 Halstead Blvd",
            "address_2": "Ste 13",
            "address_purpose": "LOCATION",
            "city": "Elizabeth City",
            "state": "NC",
            "postal_code": "279096986",
            "country_code": "US",
            "telephone_number": "252-333-3111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ACTIVE FOOT AND ANKLE OF CAROLINA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-22",
        "last_updated": "2019-04-18",
        "status": "A",
        "authorized_official_last_name": "SALEM",
        "authorized_official_first_name": "MUNJED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-333-3111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NC",
            "license": "623",
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NC",
            "license": "623",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558681197",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; 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.