NPIMap

Organization Active NPI

Heartworks Childrens Medical Home Mission

Doing business as Still Waters

  • Clinical Social Worker
  • Bayboro, NC
National Provider Identifier
1306967880
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
HEARTWORKS CHILDRENS MEDICAL HOME MISSION
Doing business as
Still Waters
Practice address
205 Main Street
Bayboro, NC 28515
Phone
(252) 745-4510
Fax
(252) 745-4511
NPI assigned
Apr 3, 2007
Last updated
Sep 28, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
HEARTWORKS CHILDRENS MEDICAL HOME MISSIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2015

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

Authorized official

Name
Lindsey Willis
Title
Billing Manager
Phone
(252) 745-4510

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

205 Main Street
Bayboro, NC 28515

Mailing address

PO Box 365
Bayboro, NC 28515-0365
Phone (252) 745-4510

Other identifiers 2

IdentifierTypeStateIssuer
016WUOtherNCBLUE CROSS GROUP NUMBER
6005232MedicaidNC

Other names 1

  • Still Waters Doing business as

National Provider Directory

National Provider Directory
Part of
Heartworks Childrens Medical Home Mission

Practitioners & affiliated clinicians

Practitioners 8

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": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443398400000",
    "number": "1306967880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "BAYBORO",
            "state": "NC",
            "postal_code": "285150365",
            "telephone_number": "252-745-4510",
            "fax_number": "252-745-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 MAIN STREET",
            "city": "BAYBORO",
            "state": "NC",
            "postal_code": "28515",
            "telephone_number": "252-745-4510",
            "fax_number": "252-745-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTWORKS CHILDRENS MEDICAL HOME MISSION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEARTWORKS CHILDRENS MEDICAL HOME MISSION",
        "enumeration_date": "2007-04-03",
        "last_updated": "2015-09-28",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "LINDSEY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "252-745-4510"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP NUMBER",
            "identifier": "016WU",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005232",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Still Waters",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bayboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.