NPIMap

Organization Active NPI

Eagle Physicians and Associates PA

Doing business as Eagle Family Medicine @ Brassfield

  • Family Medicine Physician
  • Greensboro, NC
National Provider Identifier
1710073606
Registry record updated Sep 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EAGLE PHYSICIANS AND ASSOCIATES PA
Doing business as
Eagle Family Medicine @ Brassfield
Practice address
3800 Robert Porcher Way
Suite 200
Greensboro, NC 27410-2190
Phone
(336) 282-0376
Fax
(336) 282-0379
NPI assigned
Oct 5, 2006
Last updated
Sep 24, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
EAGLE PHYSICIANS AND ASSOCIATES PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 24, 2015

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

Authorized official

Name
Terri S. Jones
Title
Director, Eagle Business Services
Phone
(336) 268-3201

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

3800 Robert Porcher Way
Suite 200
Greensboro, NC 27410-2190

Mailing address

PO Box 14883
Greensboro, NC 27415-4883
Phone (336) 282-0376

Other identifiers 2

IdentifierTypeStateIssuer
0287UOtherNCBCBS OF NC
890287UMedicaidNC

Other names 1

  • Eagle Family Medicine @ Brassfield Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031120000436 NC Part B Supplier - Clinic/Group Practice 0244134468 Receives reassigned benefits from 207 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oak Ridge, NC; Greensboro, NC

Other NPIs on the same Medicare enrollment 12

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
34D0666106Eagle Family Medicine at Brassfield3800 Robert Porcher Way Suite 200, Greensboro, NC 27410Provider-performed microscopyMar 24, 2028

National Provider Directory

National Provider Directory
Tax ID family
Tannenbaum Eagle Prim P11 organizations share this tax ID, including this one
Part of
Tannenbaum Eagle Prim P

Other organizations with this tax ID 10

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

Locations

3800 Robert Porcher Way
Greensboro, NC 27410
Phone (336) 282-0376

3800 Robert Porcher Way
Ste 200
Greensboro, NC 27410
Phone (336) 282-0376

5701 W Friendly Ave
Greensboro, NC 27410
Phone (336) 660-5100

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443052800000",
    "number": "1710073606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14883",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274154883",
            "telephone_number": "336-282-0376",
            "fax_number": "336-282-0379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 ROBERT PORCHER WAY",
            "address_2": "SUITE 200",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274102190",
            "telephone_number": "336-282-0376",
            "fax_number": "336-282-0379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE PHYSICIANS AND ASSOCIATES PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAGLE PHYSICIANS AND ASSOCIATES PA",
        "enumeration_date": "2006-10-05",
        "last_updated": "2015-09-24",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "DIRECTOR, EAGLE BUSINESS SERVICES",
        "authorized_official_telephone_number": "336-268-3201"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "0287U",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890287U",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Family Medicine @ Brassfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 24, 2015; 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.