Ethelin Camille Cammock, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

2023-02051 Issued in NC

Practice address

200 Hospital Ave
Jefferson, NC 28640-9244

Phone

(336) 846-7101

NPI assigned

May 1, 2019

Last updated

Jun 1, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, MA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ethelin.cammock.1@19847.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/19847/brand/3/csg/21/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clinch Valley Physicians Associates LLC

  dba Clinch Valley Physicians

  • Cardiovascular Disease Physician
  • Richlands, VA
  • NPI 1104265214

  Obstetrics & Gynecology

  Medicare reassignment NPD
• Mass General Brigham Medical Group Suburban Massachusetts Inc

  • Family Medicine Physician
  • Newton, MA
  • NPI 1538191218
  Medicare reassignment NPD
• Pratt OB/GYN Associates, Inc

  • Obstetrics & Gynecology Physician
  • Boston, MA
  • NPI 1336186501
  Medicare reassignment NPD
• Clinch Valley Physicians Associates LLC

  dba Clinch Valley Physicians

  • Rural Health Clinic/Center
  • Cedar Bluff, VA
  • NPI 1821339540
  NPD
• Tufts Medical Center, Inc.

  dba Tufts Medical Center

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1730132515
  NPD (past)

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

{
    "created_epoch": "1556668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717200000000",
    "number": "1386208767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 NANZETTA WAY",
            "city": "LEWISVILLE",
            "state": "NC",
            "postal_code": "270237102",
            "telephone_number": "605-660-4360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL AVE",
            "city": "JEFFERSON",
            "state": "NC",
            "postal_code": "286409244",
            "telephone_number": "336-846-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMMOCK",
        "first_name": "ETHELIN",
        "middle_name": "CAMILLE",
        "name_prefix": "Miss",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-01",
        "last_updated": "2024-06-01",
        "certification_date": "2024-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "2023-02051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Dancy Bundy, FNP-C
• Leon Carlton Burgess Jr.
• Mary Powell Burgess
• Mari Lynne Butler, A.R.N.P.
• Christopher Michael Byrd, LCSW, LCAS
• Christopher Darrell Campbell, M. D.
• Daniel Caputo, P.A.
• Fabiola Coromoto Cardozo Gallagher, MD
• Carolinas Physicians Network Inc (The Sanger Clinic)
• Charles W Jones MD PA

• Obstetrics & Gynecology Physician in Jefferson, NC
• Providers in Jefferson, NC by specialty
• Obstetrics & Gynecology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.