Active NPI
Richard Shane Coltrain, CPO
- Prosthetist
- Greenville, NC
National Provider Identifier
1417994500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- CPO 2469
- Practice address
- 1025 WH Smith Blvd
Suite 108
Greenville, NC 27834-5052 - Phone
- (252) 215-2215
- Fax
- (252) 215-2216
- NPI assigned
- May 31, 2006
- Last updated
- Apr 3, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotist | 222Z00000X | CPO 2469 | VA | |
| Prosthetist | 224P00000X | CPO 2469 | VA | Primary |
Addresses
Primary practice location
1025 WH Smith Blvd
Suite 108
Greenville, NC 27834-5052
Mailing address
1025 WH Smith Blvd
Suite 108
Greenville, NC 27834-5052
Phone (252) 215-2215
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ABC CPO 2469 | Other | NC | INDIVIDUAL ABC CERTIFICATION# |
| 7795272 | Medicaid | NC | |
| 0464J | Other | NC | NC BCBS PROVIDER# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CPO 2469 | VA | MD | Prosthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthotics & Prosthetics East Inc | Orthotist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364947200000",
"number": "1417994500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 WH SMITH BLVD",
"address_2": "SUITE 108",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278345052",
"telephone_number": "252-215-2215",
"fax_number": "252-215-2216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 WH SMITH BLVD",
"address_2": "SUITE 108",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278345052",
"telephone_number": "252-215-2215",
"fax_number": "252-215-2216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLTRAIN",
"first_name": "RICHARD",
"middle_name": "SHANE",
"name_prefix": "Mr.",
"credential": "CPO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-31",
"last_updated": "2013-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "VA",
"license": "CPO 2469",
"primary": false
},
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "VA",
"license": "CPO 2469",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIVIDUAL ABC CERTIFICATION#",
"identifier": "ABC CPO 2469",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7795272",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC BCBS PROVIDER#",
"identifier": "0464J",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.