Open Water Medical, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

30580 Issued in NC

Legal business name

OPEN WATER MEDICAL, PA

Practice address

3106 Arendell Street
Morehead City, NC 28557-3202

Phone

(252) 808-2500

Fax

(252) 808-2501

NPI assigned

Jun 8, 2015

Last updated

Feb 24, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tisha Rae Smith

Title

Practice Manager

Phone

(252) 728-5737

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

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

• Open Water Medical, PA

  • Family Medicine Physician
  • Jacksonville, NC
  • NPI 1497490957

  O20031104000183

  Same enrollment
• Open Water Medical, PA

  • Family Medicine Physician
  • Newport, NC
  • NPI 1699421065

  O20031104000183

  Same enrollment
• Open Water Medical, PA

  dba East Carteret Family Medicine

  • Primary Care Clinic/Center
  • Beaufort, NC
  • NPI 1750482493

  O20031104000183

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Open Water Medical PA6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

• Open Water Medical, PA

  • General Practice Physician
  • Sea Level, NC
  • NPI 1003730169
  NPD tax ID
• Open Water Medical, PA

  • Family Medicine Physician
  • Jacksonville, NC
  • NPI 1497490957
  NPD tax ID
• Open Water Medical, PA

  • Family Medicine Physician
  • Newport, NC
  • NPI 1699421065
  NPD tax ID
• Open Water Medical, PA

  • Clinic/Center
  • Goldsboro, NC
  • NPI 1720550940
  NPD tax ID
• Open Water Medical, PA

  dba East Carteret Family Medicine

  • Primary Care Clinic/Center
  • Beaufort, NC
  • NPI 1750482493
  NPD tax ID

Locations

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.

• Michael Henry Cartledge, PA-C

  • Physician Assistant
  • Morehead City, NC
  • NPI 1073586590
  NPD

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

{
    "created_epoch": "1433721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1669852372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 C LIVE OAK STREET",
            "city": "BEAUFORT",
            "state": "NC",
            "postal_code": "285161583",
            "telephone_number": "252-728-5737",
            "fax_number": "252-728-5739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3106 ARENDELL STREET",
            "city": "MOREHEAD CITY",
            "state": "NC",
            "postal_code": "285573202",
            "telephone_number": "252-808-2500",
            "fax_number": "252-808-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN WATER MEDICAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-08",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TISHA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "252-728-5737"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "30580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.carecloud.com",
            "affiliation": "N",
            "endpointDescription": "passwords and firewalls",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "passwords and firewalls",
            "address_1": "3106 Arendell St",
            "city": "Morehead City",
            "state": "NC",
            "country_code": "US",
            "postal_code": "285573202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• George Motley Oliver Jr., MD
• On the Move Physical Therapy and Wellness LLC
• One to One Counseling & Consulting
• Mary Jo Oneal, FNP
• Onslow Carteret Behavioral Healthcare Services
• Jennifer Wells Orr, M.D.
• Katherine Dipert Orr, MSN, RN-BC, CWOCN
• Stephanie Ortiz Page, DO
• Justin Packer
• Andrew Page

• Family Medicine Physician in Morehead City, NC
• Providers in Morehead City, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.