Individual provider Active NPI

James Steven Demetrious, DC

  • Chiropractor
  • Wilmington, NC
National Provider Identifier
1336153147
Registry record updated Feb 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1976 Issued in NC
Practice address
4837 Carolina Beach Rd
Suite 205
Wilmington, NC 28412-2368
Phone
(910) 790-8020
Fax
(910) 790-8038
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1976 NC Primary

Addresses

Primary practice location

4837 Carolina Beach Rd
Suite 205
Wilmington, NC 28412-2368

Mailing address

4837 Carolina Beach Rd
Suite 205
Wilmington, NC 28412-2368
Phone (910) 790-8020

Other identifiers 2

IdentifierTypeStateIssuer
890829PMedicaidNC
2452083OtherNCMEDICARE P TAN NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111230000235 NC Practitioner - Chiropractic 8022284736 Practice locations: Wilmington, NC

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4837 Carolina Beach Rd
Suite 205
Wilmington, NC 28412-2369
Phone (910) 790-8020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1976NCMDCounselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361750400000",
    "number": "1336153147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4837 CAROLINA BEACH RD",
            "address_2": "SUITE 205",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122368",
            "telephone_number": "910-790-8020",
            "fax_number": "910-790-8038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4837 CAROLINA BEACH RD",
            "address_2": "SUITE 205",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122368",
            "telephone_number": "910-790-8020",
            "fax_number": "910-790-8038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMETRIOUS",
        "first_name": "JAMES",
        "middle_name": "STEVEN",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2013-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "1976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890829P",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE P TAN NUMBER",
            "identifier": "2452083",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.