NPIMap

Organization Active NPI

Open Water Medical, PA

  • Family Medicine Physician
  • Newport, NC
National Provider Identifier
1699421065
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OPEN WATER MEDICAL, PA
Practice address
263 Howard Blvd
Newport, NC 28570-7927
Phone
(252) 728-5737
Fax
(252) 728-5739
NPI assigned
Feb 24, 2022
Last updated
Feb 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

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

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

263 Howard Blvd
Newport, NC 28570-7927

Mailing address

1620C Live Oak St
Beaufort, NC 28516-1583
Phone (252) 728-5737

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.carecloud.com Health Information Exchange (HIE) OPEN WATER MEDICAL, PA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031104000183 NC Part B Supplier - Clinic/Group Practice 2961314315 Receives reassigned benefits from 7 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Zebulon, NC; Newport, NC; Morehead City, NC; Jacksonville, NC; Goldsboro, NC; Beaufort, NC

Other NPIs on the same Medicare enrollment 3

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2254449Open Water Medical, PA263 Howard Blvd, Newport, NC 28570Certificate of waiverMar 2, 2028

National Provider Directory

National Provider Directory
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.

Locations

1620 Live Oak St
Ste C
Beaufort, NC 28516
Phone (252) 728-5737

540 Cedar Point Blvd
Cedar Point, NC 28584
Phone (252) 393-2532

263 Howard Blvd
Newport, NC 28570
Phone (252) 359-4708

109 S Vance St
Sanford, NC 27330
Phone (910) 682-7636

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1645660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1699421065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620C LIVE OAK ST",
            "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": "263 HOWARD BLVD",
            "city": "NEWPORT",
            "state": "NC",
            "postal_code": "285707927",
            "telephone_number": "252-728-5737",
            "fax_number": "252-728-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN WATER MEDICAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-24",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.carecloud.com",
            "affiliation": "Y",
            "endpointDescription": "passwords and firwalls",
            "affiliationName": "OPEN WATER MEDICAL, PA",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "All computer are secure locations and faxed secure",
            "address_1": "263 Howard Blvd",
            "city": "Newport",
            "state": "NC",
            "country_code": "US",
            "postal_code": "285707927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Newport, NC

Sources for this page

  • 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.