Elliott John Sally, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2020-02658 Issued in NC

Practice address

1050 Jabara Ave
Sjafb, Pediatric Clinic
Goldsboro, NC 27531-2310

Phone

(919) 722-1536

NPI assigned

Feb 15, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: esally463834@direct.medicine.duke.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Duke University Affiliated Physicians, Inc.

  • Internal Medicine Physician
  • Durham, NC
  • NPI 1316975972
  Medicare reassignment NPD
• Duke University Affiliated Physicians, Inc.

  • Emergency Medicine Physician
  • Raleigh, NC
  • NPI 1710120795
  NPD
• Duke University Affiliated Physicians, Inc.

  • Family Medicine Physician
  • Durham, NC
  • NPI 1225073554
  NPD (past)

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

{
    "created_epoch": "1329264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1538432018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5213 S ALSTON AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277134430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 JABARA AVE",
            "address_2": "SJAFB, PEDIATRIC CLINIC",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275312310",
            "telephone_number": "919-722-1536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALLY",
        "first_name": "ELLIOTT",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-02-15",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2020-02658",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0102204044",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivane Sinai Saenz, LCSWA
• Vivek Jagdish Sainani, M.D.
• James D Salisbury, DO
• Margaret Ellen Salisbury, PA-C
• Sally Lewis Grant, LLC
• Carolyn M Sampson, M.D.
• Sams East Inc
• Victoria R Samuels, M.D.
• Judith Daniels Sanders, CRNA
• Arundeep Sandhu, DDS

• Pediatrics Physician in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.