NPIMap

Organization Active NPI

Southeastern Medical, PA

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Sunset Beach, NC
National Provider Identifier
1467006197
Registry record updated Jul 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
Legal business name
SOUTHEASTERN MEDICAL, PA
Practice address
830 Sunset Blvd N
Sunset Beach, NC 28468-4262
Phone
(910) 575-5750
NPI assigned
Jul 31, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2019

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

Authorized official

Name
Alicia Berry
Title
Insurance Supervisor
Phone
(910) 287-7001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2081P2900X Primary

Addresses

Primary practice location

830 Sunset Blvd N
Sunset Beach, NC 28468-4262

Mailing address

830 Sunset Blvd N
Sunset Beach, NC 28468-4262
Phone (910) 575-5750

Other identifiers 1

IdentifierTypeStateIssuer
8911413MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Southeastern Rehab PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

830 Sunset Blvd N
Sunset Beach, NC 28468
Phone (910) 575-5750

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DAHBDD

Practitioners & affiliated clinicians

Practitioners 4

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": "1564531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564531200000",
    "number": "1467006197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 SUNSET BLVD N",
            "city": "SUNSET BEACH",
            "state": "NC",
            "postal_code": "284684262",
            "telephone_number": "910-575-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 SUNSET BLVD N",
            "city": "SUNSET BEACH",
            "state": "NC",
            "postal_code": "284684262",
            "telephone_number": "910-575-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN MEDICAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-31",
        "last_updated": "2019-07-31",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "INSURANCE SUPERVISOR",
        "authorized_official_telephone_number": "910-287-7001"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8911413",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunset Beach, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.