NPIMap

Organization Active NPI

Urology Associates of Southeastern North Carolina, PA

  • Specialist
  • Wilmington, NC
National Provider Identifier
1407875610
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
40206 Issued in NC
Legal business name
UROLOGY ASSOCIATES OF SOUTHEASTERN NORTH CAROLINA, PA
Practice address
1905 Glen Meade Rd
Wilmington, NC 28403-6024
Phone
(910) 763-6251
Fax
(910) 763-7408
NPI assigned
Jul 19, 2006
Last updated
Feb 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

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

Authorized official

Name
Amy Arlene Watson
Title
Practice Administrator
Phone
(910) 763-6251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 40206 NC Primary

Addresses

Primary practice location

1905 Glen Meade Rd
Wilmington, NC 28403-6024

Mailing address

1905 Glen Meade Rd
Wilmington, NC 28403-6024
Phone (910) 763-6251

Other identifiers 1

IdentifierTypeStateIssuer
8901777MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040227000094 NC Part B Supplier - Clinic/Group Practice 5092601872 Receives reassigned benefits from 14 practitioners
Practice locations: Southport, NC; Wilmington, NC; Leland, NC

National Provider Directory

National Provider Directory

Locations

9 Medical Center Dr
Supply, NC 28462
Phone (910) 754-7400

1810 Glen Meade Rd
Wilmington, NC 28403
Phone (910) 763-6251

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675209600000",
    "number": "1407875610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 GLEN MEADE RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036024",
            "telephone_number": "910-763-6251",
            "fax_number": "910-763-7408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 GLEN MEADE RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036024",
            "telephone_number": "910-763-6251",
            "fax_number": "910-763-7408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UROLOGY ASSOCIATES OF SOUTHEASTERN NORTH CAROLINA, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "ARLENE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "910-763-6251"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "40206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901777",
            "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 1, 2023; 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.