NPIMap

Organization Active NPI

Survivor Friendly LLC

  • Durable Medical Equipment & Medical Supplies
  • Durham, NC
National Provider Identifier
1609542083
Registry record updated Aug 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SURVIVOR FRIENDLY LLC
Practice address
20 Duke Medicine Circle
Self Image Boutique Prosthetics RM 0N14
Durham, NC 27710-0001
Phone
(919) 747-9336
NPI assigned
Aug 17, 2021
Last updated
Aug 17, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SURVIVOR FRIENDLY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 17, 2021

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

Authorized official

Name
Jacqueline Cromity
Title
Owner
Phone
(919) 474-9336

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

20 Duke Medicine Circle
Self Image Boutique Prosthetics RM 0N14
Durham, NC 27710-0001

Mailing address

20 Duke Medicine Circle
Self Image Boutique Prosthetics RM 0N14
Durham, NC 27710

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230613001122 NC DME Supplier - Medical Supply CompanyDME Supplier - Medical Supply Company With Orthotic-Prosthetic 1658785449 Practice locations: Durham, NC

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Survivor Friendly LLC6 organizations share this tax ID, including this one
Part of
Survivor Friendly LLC

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

20 Duke Medicine Cir
Rm 0N14
Durham, NC 27710
Phone (919) 613-1905

4101 Macon Pond Rd
#1290
Raleigh, NC 27607
Phone (919) 307-0160

4101 Macon Pond Rd
Rm 1158
Raleigh, NC 27607
Phone (919) 307-0160

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629158400000",
    "number": "1609542083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 DUKE MEDICINE CIRCLE",
            "address_2": "SELF IMAGE BOUTIQUE PROSTHETICS RM 0N14",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 DUKE MEDICINE CIRCLE",
            "address_2": "SELF IMAGE BOUTIQUE PROSTHETICS RM 0N14",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277100001",
            "telephone_number": "919-747-9336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURVIVOR FRIENDLY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SURVIVOR FRIENDLY LLC",
        "enumeration_date": "2021-08-17",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A",
        "authorized_official_last_name": "CROMITY",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-474-9336"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; 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.