NPIMap

Organization Active NPI

Outreach Management Services LLC

  • Community/Behavioral Health Agency
  • Gastonia, NC
National Provider Identifier
1417080680
Registry record updated Feb 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL-036-235 Issued in NC
Legal business name
OUTREACH MANAGEMENT SERVICES LLC
Practice address
1723 Armstrong Park Dr
Gastonia, NC 28054-4802
Phone
(704) 854-9828
Fax
(704) 854-9882
NPI assigned
Mar 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2010

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

Authorized official

Name
Mr. Alexander Xavier Walker, QP
Title
Executive Director
Phone
(704) 854-9828

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X MHL-036-235 NC
Community/Behavioral Health Agency 251S00000X MHL-036-235 NC Primary

Addresses

Primary practice location

1723 Armstrong Park Dr
Gastonia, NC 28054-4802

Mailing address

1723 Armstrong Park Dr
Gastonia, NC 28054-4802
Phone (704) 854-9828

Other identifiers 7

IdentifierTypeStateIssuer
8300696DMedicaidNC
8300696MedicaidNC
8300696GMedicaidNC
8300696HMedicaidNC
8300696QMedicaidNC
6005781MedicaidNC
8300696BMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090825000746 NC Part A Provider - Community Mental Health Center 6800941923 Practice locations: Gastonia, NC
O20171122000321 NC Part B Supplier - Clinic/Group Practice 6800941923 Receives reassigned benefits from 8 practitioners
Practice locations: Gastonia, NC

National Provider Directory

National Provider Directory
Tax ID family
Outreach Management Services LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1723 Armstrong Park Dr
Gastonia, NC 28054
Phone (704) 854-9828

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266364800000",
    "number": "1417080680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1723 ARMSTRONG PARK DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544802",
            "telephone_number": "704-854-9828",
            "fax_number": "704-854-9882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1723 ARMSTRONG PARK DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544802",
            "telephone_number": "704-854-9828",
            "fax_number": "704-854-9882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH MANAGEMENT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2010-02-17",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "XAVIER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-854-9828",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "QP"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NC",
            "license": "MHL-036-235",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL-036-235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300696D",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300696",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300696G",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300696H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300696Q",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005781",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300696B",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2010; 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.