NPIMap

Organization Active NPI

Port Health Services

  • Community/Behavioral Health Agency
  • Rocky Mount, NC
National Provider Identifier
1306315924
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PORT HEALTH SERVICES
Practice address
132 Foy Dr
Rocky Mount, NC 27804-2417
Phone
(252) 413-1916
Fax
(252) 210-3120
NPI assigned
Nov 14, 2018
Last updated
May 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

132 Foy Dr
Rocky Mount, NC 27804-2417

Mailing address

4300 Sapphire CT Ste 110
Greenville, NC 27834-9079
Phone (252) 830-7540

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050726001211 NC Part B Supplier - Clinic/Group Practice 5193752681 Receives reassigned benefits from 43 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wilmington, NC; Whiteville, NC; Washington, NC; Rocky Mount, NC; New Bern, NC; Nags Head, NC; Morehead City, NC; Kinston, NC…

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Port Health Services38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

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

View all 37

Practitioners & affiliated clinicians

Practitioners 2

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": "1542153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1306315924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 SAPPHIRE CT STE 110",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278349079",
            "telephone_number": "252-830-7540",
            "fax_number": "252-413-0932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 FOY DR",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278042417",
            "telephone_number": "252-413-1916",
            "fax_number": "252-210-3120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-14",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "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": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rocky Mount, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.