Individual provider Active NPI

Elizabeth Anne Eagle, MD

  • Diagnostic Radiology Physician
  • Greensboro, NC
National Provider Identifier
1700877479
Registry record updated Mar 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
26437 Issued in NC
Practice address
1331 North Elm Street
Suite 200
Greensboro, NC 27401-6304
Phone
(336) 274-9617
Fax
(336) 482-2177
NPI assigned
Nov 2, 2005
Last updated
Mar 17, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 26437 NC Primary

Addresses

Primary practice location

1331 North Elm Street
Suite 200
Greensboro, NC 27401-6304

Mailing address

1331 North Elm Street
Suite 200
Greensboro, NC 27401-6304
Phone (336) 274-9617

Other identifiers 6

IdentifierTypeStateIssuer
1600340OtherNCUNITED HEALTHCARE
1080OtherNCPARTNERS
29714OtherNCBLUE CROSS BLUE SHIELD
300050401OtherNCRAILROAD MEDICARE
70508OtherNCMEDCOST
8929714MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26437NCMDDiagnostic Radiology Physician

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395014400000",
    "number": "1700877479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 NORTH ELM STREET",
            "address_2": "SUITE 200",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274016304",
            "telephone_number": "336-274-9617",
            "fax_number": "336-482-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 NORTH ELM STREET",
            "address_2": "SUITE 200",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274016304",
            "telephone_number": "336-274-9617",
            "fax_number": "336-482-2177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EAGLE",
        "first_name": "ELIZABETH",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2014-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "26437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1600340",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "1080",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "29714",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300050401",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "70508",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8929714",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.