NPIMap

Organization Active NPI

Eagle Physicians and Associates PA

Doing business as Eagle Walk-In Clinic

  • Family Medicine Physician
  • Greensboro, NC
National Provider Identifier
1407929094
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EAGLE PHYSICIANS AND ASSOCIATES PA
Doing business as
Eagle Walk-In Clinic
Practice address
5701 W Friendly Ave
Greensboro, NC 27410-4112
Phone
(336) 852-1915
Fax
(336) 294-3544
NPI assigned
Nov 15, 2006
Last updated
Jun 13, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
EAGLE PHYSICIANS AND ASSOCIATES PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Authorized official

Name
Terri S. Jones
Title
Director, Eagle Business Services
Phone
(336) 268-3201

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

5701 W Friendly Ave
Greensboro, NC 27410-4112

Mailing address

PO Box 14883
Greensboro, NC 27415-4883
Phone (336) 482-2723

Other identifiers 2

IdentifierTypeStateIssuer
89011T0MedicaidNC
011T0OtherNCBCBS OF NC

Other names 1

  • Eagle Walk-In Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031120000436 NC Part B Supplier - Clinic/Group Practice 0244134468 Receives reassigned benefits from 207 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oak Ridge, NC; Greensboro, NC

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Part of
Tannenbaum Eagle Prim P

Locations

1002 N Church St
Ste 201
Greensboro, NC 27401
Phone (336) 378-0713

603A Dolley Madison Rd
Greensboro, NC 27410
Phone (336) 294-6190

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1407929094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14883",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274154883",
            "telephone_number": "336-482-2723",
            "fax_number": "336-294-3544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 W FRIENDLY AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274104112",
            "telephone_number": "336-852-1915",
            "fax_number": "336-294-3544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE PHYSICIANS AND ASSOCIATES PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAGLE PHYSICIANS AND ASSOCIATES PA",
        "enumeration_date": "2006-11-15",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "DIRECTOR, EAGLE BUSINESS SERVICES",
        "authorized_official_telephone_number": "336-268-3201"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89011T0",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "011T0",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Walk-In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.