Organization Active NPI

Community Family Practice Physicians

  • Family Medicine Physician
  • Elizabeth City, NC
National Provider Identifier
1306986278
Registry record updated Feb 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19404 Issued in NC
Legal business name
COMMUNITY FAMILY PRACTICE PHYSICIANS
Practice address
107 Medical Dr
Elizabeth City, NC 27909-3361
Phone
(252) 335-0503
NPI assigned
Feb 8, 2007
Last updated
Feb 24, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2011

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

Authorized official

Name
Dr. Joseph Milton Spruill Jr., M.D.NPI 1356489835
Title
President
Phone
(252) 335-0503

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 19404 NC Primary

Addresses

Primary practice location

107 Medical Dr
Elizabeth City, NC 27909-3361

Mailing address

107 Medical Dr
Elizabeth City, NC 27909-3361
Phone (252) 335-0503

Other identifiers 2

IdentifierTypeStateIssuer
5950232MedicaidNC
34D0242422OtherCLIA ID NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110307001015 NC Part B Supplier - Clinic/Group Practice 5991987349 Receives reassigned benefits from 2 practitioners
Practice locations: Elizabeth City, NC

National Provider Directory

National Provider Directory

Locations

107 Medical Dr
Elizabeth Cty, NC 27909
Phone (252) 335-0503

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": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298505600000",
    "number": "1306986278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 MEDICAL DR",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279093361",
            "telephone_number": "252-335-0503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 MEDICAL DR",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279093361",
            "telephone_number": "252-335-0503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY FAMILY PRACTICE PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2011-02-24",
        "status": "A",
        "authorized_official_last_name": "SPRUILL",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "MILTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-335-0503",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "19404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950232",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID NUMBER",
            "identifier": "34D0242422",
            "state": null
        }
    ],
    "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 Feb 24, 2011; 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.