NPIMap

Organization Active NPI

Greenville Family Doctors, PA

  • Family Medicine Physician
  • Greenville, NC
National Provider Identifier
1629129119
Registry record updated May 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GREENVILLE FAMILY DOCTORS, PA
Practice address
800 Moye Blvd Ste a
Greenville, NC 27834-3777
Phone
(252) 752-7133
Fax
(252) 752-6120
NPI assigned
Jan 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2020

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

Authorized official

Name
Dr. Quentin Alexander Mewborn Jr., MDNPI 1831240308
Title
President
Phone
(252) 752-7133

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

800 Moye Blvd Ste a
Greenville, NC 27834-3777

Mailing address

800 Moye Blvd Ste a
Greenville, NC 27834-3777
Phone (252) 752-7133

Other identifiers 2

IdentifierTypeStateIssuer
8901678MedicaidNC
230285OtherNCMEDICARE PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071026000589 NC Part B Supplier - Clinic/Group Practice 2365348927 Receives reassigned benefits from 7 practitioners
Practice locations: Greenville, NC

National Provider Directory

National Provider Directory

Locations

800 Moye Blvd
Ste A
Greenville, NC 27834
Phone (252) 752-7133

2210 Hemby Ln
Ste 105
Greenville, NC 27834
Phone (252) 752-7133

Practitioners & affiliated clinicians

Practitioners 9

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": "1168646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588550400000",
    "number": "1629129119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MOYE BLVD STE A",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278343777",
            "telephone_number": "252-752-7133",
            "fax_number": "252-752-6120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MOYE BLVD STE A",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278343777",
            "telephone_number": "252-752-7133",
            "fax_number": "252-752-6120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE FAMILY DOCTORS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-13",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A",
        "authorized_official_last_name": "MEWBORN",
        "authorized_official_first_name": "QUENTIN",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-752-7133",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901678",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "230285",
            "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 4, 2020; 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.