Active NPI
Jonathan Privette, M.D.
- Anatomic Pathology Physician
- Greenville, NC
National Provider Identifier
1508079658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology Physician
- License
- 2008-01686
- Practice address
- 600 Moye Blvd
Ecu Physicians Brody Outpatient Center
Greenville, NC 27834-4300 - Phone
- (252) 744-4655
- Fax
- (252) 744-3650
- NPI assigned
- May 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Forensic Pathology Physician | 207ZF0201X | 2008-01686 | NC | |
| Anatomic Pathology Physician | 207ZP0101X | 2008-01686 | NC | Primary |
Addresses
Primary practice location
600 Moye Blvd
Ecu Physicians Brody Outpatient Center
Greenville, NC 27834-4300
Mailing address
PO Box 751069
Ecu Physicians
Charlotte, NC 28275-1069
Phone (252) 744-3258
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5922084 | Medicaid | NC | |
| 174UW | Other | NC | BCBS |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2008-01686 | NC | MD | Anatomic Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364428800000",
"number": "1508079658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 751069",
"address_2": "ECU PHYSICIANS",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282751069",
"telephone_number": "252-744-3258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 MOYE BLVD",
"address_2": "ECU PHYSICIANS BRODY OUTPATIENT CENTER",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278344300",
"telephone_number": "252-744-4655",
"fax_number": "252-744-3650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRIVETTE",
"first_name": "JONATHAN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-07",
"last_updated": "2013-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "207ZF0201X",
"taxonomy_group": "",
"desc": "Pathology, Forensic Pathology",
"state": "NC",
"license": "2008-01686",
"primary": false
},
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "NC",
"license": "2008-01686",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5922084",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "174UW",
"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 Mar 28, 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.