NPIMap

Organization Active NPI

Sampson Regional Professional Services

Doing business as Carolina Pain Center

  • Pain Medicine (Anesthesiology) Physician
  • Clinton, NC
National Provider Identifier
1316298458
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
SAMPSON REGIONAL PROFESSIONAL SERVICES
Doing business as
Carolina Pain Center
Practice address
518 Beaman St
Clinton, NC 28328-2602
Phone
(910) 596-4288
NPI assigned
Sep 28, 2012
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Hunter Balltzglier
Title
Director
Phone
(910) 590-8755

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 200301024 NC
Pain Medicine (Anesthesiology) Physician 207LP2900X Primary

Addresses

Primary practice location

518 Beaman St
Clinton, NC 28328-2602

Mailing address

607 Beaman St
Clinton, NC 28328-2603
Phone (910) 590-8755

Other practice location 1

417 Vance St
Suite C
Clinton, NC 28328-4001
Phone (910) 596-4288

Other identifiers 1

IdentifierTypeStateIssuer
00492OtherNCBCBS

Other names 1

  • Carolina Pain Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091014000771 NC Part B Supplier - Clinic/Group Practice 6406992817 Receives reassigned benefits from 33 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, NC; Roseboro, NC; Newton Grove, NC

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Sampson Regional Professional Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

417 Vance St
#C
Clinton, NC 28328
Phone (910) 596-4288

518 Beaman St
Clinton, NC 28328
Phone (910) 590-5312

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": "1348790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1316298458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 BEAMAN ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282603",
            "telephone_number": "910-590-8755",
            "fax_number": "910-596-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 BEAMAN ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282602",
            "telephone_number": "910-596-4288"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "417 Vance St",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "NC",
            "postal_code": "283284001",
            "country_code": "US",
            "telephone_number": "910-596-4288",
            "fax_number": "910-592-3384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAMPSON REGIONAL PROFESSIONAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-28",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BALLTZGLIER",
        "authorized_official_first_name": "HUNTER",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-590-8755",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "200301024",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00492",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Pain Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.