NPIMap

Organization Active NPI

Eastern Dermatology, P.a.

  • Dermatology Physician
  • Greenville, NC
National Provider Identifier
1598759482
Registry record updated May 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
EASTERN DERMATOLOGY, P.A.
Practice address
420 Spring Forest Rd
Greenville, NC 27834-7244
Phone
(252) 752-4124
Fax
(252) 758-8954
NPI assigned
Sep 7, 2005
Last updated
May 20, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2013

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

Authorized official

Name
Dr. Cameron Langley Smith, M.D.NPI 1770504060
Title
President
Phone
(252) 752-4124

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X
Pediatric Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NP0225X
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

420 Spring Forest Rd
Greenville, NC 27834-7244

Mailing address

420 Spring Forest Rd
Greenville, NC 27834-7244
Phone (252) 752-4124

Other identifiers 2

IdentifierTypeStateIssuer
5922478MedicaidNC
01498OtherNCBCBS OF NC GROUP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040624001141 NC Part B Supplier - Clinic/Group Practice 2860478542 Receives reassigned benefits from 21 practitioners
3 other NPIs on this enrollment
Practice locations: Newport, NC; Washington, NC; New Bern, NC; Greenville, NC; Elizabeth City, NC; Edenton, NC

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

204 Earnhart Dr
Edenton, NC 27932

1840 Highway 24
Newport, NC 28570
Phone (252) 223-0400

3311 Trent Rd
Trent Woods, NC 28562
Phone (252) 634-2885

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369008000000",
    "number": "1598759482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 SPRING FOREST RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278347244",
            "telephone_number": "252-752-4124",
            "fax_number": "252-758-8954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 SPRING FOREST RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278347244",
            "telephone_number": "252-752-4124",
            "fax_number": "252-758-8954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN DERMATOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-07",
        "last_updated": "2013-05-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_middle_name": "LANGLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-752-4124",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5922478",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC GROUP",
            "identifier": "01498",
            "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 May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.