NPIMap

Organization Active NPI

Crossroads Sexual Assault Response & Resource Center Inc

  • Pediatrics Physician
  • Burlington, NC
National Provider Identifier
1508190067
Registry record updated Feb 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CROSSROADS SEXUAL ASSAULT RESPONSE & RESOURCE CENTER INC
Practice address
1206 Vaughn Rd
Suite B
Burlington, NC 27217-2847
Phone
(336) 228-0813
Fax
(336) 228-7087
NPI assigned
Sep 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2010

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

Authorized official

Name
Dr. Dana M Hagele, MD, MPH
Title
MD
Phone
(336) 228-0813

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 6879 NC
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1206 Vaughn Rd
Suite B
Burlington, NC 27217-2847

Mailing address

PO Box 673
Burlington, NC 27216-0673
Phone (336) 228-0813

Other identifiers 1

IdentifierTypeStateIssuer
5912904MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Crossroads Sexual Assault Resp Resourc2 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

1206 Vaughn Rd
Burlington, NC 27217
Phone 3362280813 ext. 116

Practitioners & affiliated clinicians

Practitioners 3

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": "1254268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265932800000",
    "number": "1508190067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 673",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272160673",
            "telephone_number": "336-228-0813",
            "fax_number": "336-228-7087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 VAUGHN RD",
            "address_2": "SUITE B",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272172847",
            "telephone_number": "336-228-0813",
            "fax_number": "336-228-7087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS SEXUAL ASSAULT RESPONSE & RESOURCE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-30",
        "last_updated": "2010-02-12",
        "status": "A",
        "authorized_official_last_name": "HAGELE",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "336-228-0813",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MPH"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "6879",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5912904",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; 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.