NPIMap

Individual provider Active NPI

Phillip Gordon Harris, M.D.

  • Family Medicine Physician
  • Windsor, NC
National Provider Identifier
1649228750
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34986 Issued in NC
Practice address
1403 S King St
Windsor, NC 27983-9666
Phone
(252) 794-6775
Fax
(252) 794-6771
NPI assigned
May 4, 2006
Last updated
Apr 29, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34986 NC Primary

Addresses

Primary practice location

1403 S King St
Windsor, NC 27983-9666

Mailing address

1403 S King St
Windsor, NC 27983-9666
Phone (252) 794-6775

Other identifiers 2

IdentifierTypeStateIssuer
8944403OtherNCMEDICAID
39985OtherNCBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041111000545 NC Practitioner - Family Practice 2062475882 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Brody School of Medicine at East Carolina University, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians
East Carolina Health-BertieGroup PAC ID 1355251661, 5 clinicians

Practice addresses (Care Compare)

1403 S King St
Windsor, NC 27983-9666
Phone (252) 794-6700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34986NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Carolina Health-Bertie CurrentSince Oct 1, 2004 Accepting new patients
Vidant Medical Group LLC CurrentSince Dec 1, 2009 Accepting new patients
Vidant Medical Group LLC CurrentSince Dec 1, 2009 Accepting new patients
East Carolina Health-Bertie Family Medicine Current Accepting new patients
East Carolina Health-Bertie CurrentSince Oct 1, 2004 Accepting new patients

Locations

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

1403 S King St
Windsor, NC 27983
Phone (252) 794-6685

Interoperability endpoints

  • Direct secure messaging: pharris24983@direct.ecuhealth.com

Organizations & group practices 5

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

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1649228750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 S KING ST",
            "city": "WINDSOR",
            "state": "NC",
            "postal_code": "279839666",
            "telephone_number": "252-794-6775",
            "fax_number": "252-794-6771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 S KING ST",
            "city": "WINDSOR",
            "state": "NC",
            "postal_code": "279839666",
            "telephone_number": "252-794-6775",
            "fax_number": "252-794-6771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "PHILLIP",
        "middle_name": "GORDON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "34986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "8944403",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "39985",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor, NC

Sources for this page

Verify at the official NPI Registry.