Individual provider Active NPI

Richard Phillips Eide III, M.D.

  • Public Health & General Preventive Medicine Physician
  • Fort Bragg, NC
National Provider Identifier
1548571714
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X
License
67375 Issued in GA
Practice address
2817 Rock Merritt Ave
Fort Bragg, NC 28310-0001
Phone
(910) 907-8922
Fax
(910) 907-6069
NPI assigned
Jun 23, 2010
Last updated
Jun 3, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 67375 GA
Public Health & General Preventive Medicine Physician 2083P0901X 67375 GA Primary

Addresses

Primary practice location

2817 Rock Merritt Ave
Fort Bragg, NC 28310-0001

Mailing address

2817 Rock Merritt Ave
Fort Bragg, NC 28310-0001
Phone (910) 907-8922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20151119002478 KY Order and Referring Only - Family PracticePractitioner - Family Practice 2163722398

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
67375GAMDPublic Health & General Preventive Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1548571714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-8922",
            "fax_number": "910-907-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-8922",
            "fax_number": "910-907-6069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EIDE",
        "first_name": "RICHARD",
        "middle_name": "PHILLIPS",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-23",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "67375",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "GA",
            "license": "67375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Bragg, NC

Sources for this page

Verify at the official NPI Registry.