NPIMap

Organization Active NPI

Sandy Shores Primary Care, PLLC

  • Primary Care Clinic/Center
  • Surf City, NC
National Provider Identifier
1508511767
Registry record updated Feb 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SANDY SHORES PRIMARY CARE, PLLC
Practice address
13741 NC Highway 50 Ste a
Surf City, NC 28445-6935
Phone
(910) 777-2732
Fax
(910) 777-2742
NPI assigned
Feb 16, 2022
Organization subpart
Yes
Parent organization
SANDY SHORES MEDICAL CENTER AND URGENT CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 16, 2022

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

Authorized official

Name
Rebecca L Cooper, PACNPI 1104159540
Title
Owner
Phone
(910) 789-9883

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

13741 NC Highway 50 Ste a
Surf City, NC 28445-6935

Mailing address

13741 NC Highway 50 Ste a
Surf City, NC 28445-6935
Phone (910) 777-2782

Other identifiers 1

IdentifierTypeStateIssuer
1104159540MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.ssmcuc.net Direct Sandy Shores Medical Center and Urgent Care

National Provider Directory

National Provider Directory
Part of
Sandy Shores Medical Center

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 10

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": "1644969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1508511767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13741 NC HIGHWAY 50 STE A",
            "city": "SURF CITY",
            "state": "NC",
            "postal_code": "284456935",
            "telephone_number": "910-777-2782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13741 NC HIGHWAY 50 STE A",
            "city": "SURF CITY",
            "state": "NC",
            "postal_code": "284456935",
            "telephone_number": "910-777-2732",
            "fax_number": "910-777-2742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDY SHORES PRIMARY CARE, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANDY SHORES MEDICAL CENTER AND URGENT CARE",
        "enumeration_date": "2022-02-16",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-789-9883",
        "authorized_official_credential": "PAC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104159540",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.ssmcuc.net",
            "affiliation": "Y",
            "endpointDescription": "Clinic's Website address",
            "affiliationName": "Sandy Shores Medical Center and Urgent Care",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Messaging, questionares",
            "address_1": "13741 Nc Highway 50 Ste A",
            "city": "Surf City",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284456935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Surf City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.