Open Water Medical, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

OPEN WATER MEDICAL, PA

Practice address

11 Office Park Dr
Jacksonville, NC 28546-7326

Phone

(910) 353-9906

Fax

(910) 353-4853

NPI assigned

Apr 29, 2022

Last updated

Apr 29, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tisha Rae Smith

Title

Practice Manager

Phone

(252) 728-5737

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

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

• Open Water Medical, PA

  • Family Medicine Physician
  • Morehead City, NC
  • NPI 1669852372

  O20031104000183

  Same enrollment
• Open Water Medical, PA

  • Family Medicine Physician
  • Newport, NC
  • NPI 1699421065

  O20031104000183

  Same enrollment
• Open Water Medical, PA

  dba East Carteret Family Medicine

  • Primary Care Clinic/Center
  • Beaufort, NC
  • NPI 1750482493

  O20031104000183

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Open Water Medical PA6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

• Open Water Medical, PA

  • General Practice Physician
  • Sea Level, NC
  • NPI 1003730169
  NPD tax ID
• Open Water Medical, PA

  • Family Medicine Physician
  • Morehead City, NC
  • NPI 1669852372
  NPD tax ID
• Open Water Medical, PA

  • Family Medicine Physician
  • Newport, NC
  • NPI 1699421065
  NPD tax ID
• Open Water Medical, PA

  • Clinic/Center
  • Goldsboro, NC
  • NPI 1720550940
  NPD tax ID
• Open Water Medical, PA

  dba East Carteret Family Medicine

  • Primary Care Clinic/Center
  • Beaufort, NC
  • NPI 1750482493
  NPD tax ID

Practitioners 1

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.

• Robert Allen Krause, MD

  • Family Medicine Physician
  • Jacksonville, NC
  • NPI 1346231388
  NPD

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

{
    "created_epoch": "1651190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651190400000",
    "number": "1497490957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620C LIVE OAK ST",
            "city": "BEAUFORT",
            "state": "NC",
            "postal_code": "285161583",
            "telephone_number": "252-728-5737",
            "fax_number": "252-728-5739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 OFFICE PARK DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467326",
            "telephone_number": "910-353-9906",
            "fax_number": "910-353-4853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN WATER MEDICAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-29",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TISHA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "252-728-5737"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750482493",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://openwatermedical.com/",
            "affiliation": "Y",
            "endpointDescription": "https://openwatermedical.com/",
            "affiliationName": "OPEN WATER MEDICAL, PA",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "https://openwatermedical.com/",
            "address_1": "1620 Live Oak St Ste C",
            "city": "Beaufort",
            "state": "NC",
            "country_code": "US",
            "postal_code": "285161582",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Onslow Surgical Clinic PA
• Onslow United Transit System, Inc.
• Onslow Urgent Care
• Onslow Urology Clinic
• Open Door MGMT Agency of Jacksonville
• Open Water Wellness PLLC
• Alicia Orlopp, LPC
• James Ryan Orr
• Veronica Ortiz Rivera, LCSWA
• Valery Ortiz

• Family Medicine Physician in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.