Individual provider Active NPI

Joseph Ray Haskett Jr., MD

  • Internal Medicine Physician
  • Edenton, NC
National Provider Identifier
1669461729
Registry record updated Nov 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20912 Issued in NC
Practice address
104 Mark Dr
Edenton, NC 27932-1756
Phone
(252) 482-5171
Fax
(252) 482-5173
NPI assigned
Oct 20, 2005
Last updated
Nov 2, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 20912 NC Primary

Addresses

Primary practice location

104 Mark Dr
Edenton, NC 27932-1756

Mailing address

PO Box 1210
104 Mark Drive
Edenton, NC 27932-1210
Phone (252) 482-5171

Other identifiers 3

IdentifierTypeStateIssuer
7940397MedicaidNC
34DO242548OtherNCCLIA
40397OtherNCBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20100414000590 NC Practitioner - Internal Medicine 5991831471

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20912NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Edenton Internal Medicine PA Internal Medicine CurrentSince Nov 29, 1994 Accepting new patients
Vidant Medical Group LLC CurrentSince Aug 1, 2012 Accepting new patients

Locations

104 Mark Dr
Edenton, NC 27932
Phone (252) 482-5171

211 Virginia Rd
Edenton, NC 27932
Phone (252) 384-2590

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

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

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257120000000",
    "number": "1669461729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1210",
            "address_2": "104 MARK DRIVE",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321210",
            "telephone_number": "252-482-5171",
            "fax_number": "252-482-5173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MARK DR",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321756",
            "telephone_number": "252-482-5171",
            "fax_number": "252-482-5173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASKETT",
        "first_name": "JOSEPH",
        "middle_name": "RAY",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2009-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "20912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7940397",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "34DO242548",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "40397",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edenton, NC

Sources for this page

Verify at the official NPI Registry.