NPIMap

Individual provider Active NPI

James McCubbin, M.D.

  • Basic Emergency Medical Technician
  • South Boston, VA
National Provider Identifier
1720090376
Registry record updated Jan 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Basic Emergency Medical TechnicianTaxonomy code 146N00000X
License
0101243579 Issued in VA
Practice address
2204 Wilborn Ave
South Boston, VA 24592-1645
Phone
(434) 517-3123
NPI assigned
Aug 12, 2006
Last updated
Jan 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Basic Emergency Medical Technician 146N00000X 0101243579 VA Primary
Emergency Medicine Physician 207P00000X 0101243579 VA

Addresses

Primary practice location

2204 Wilborn Ave
South Boston, VA 24592-1645

Mailing address

1122 Brook Run Rd
Halifax, VA 24558-3004
Phone (434) 476-2421

Other identifiers 1

IdentifierTypeStateIssuer
1720090376OtherVANPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090529000169 VA Practitioner - Emergency Medicine 6305808015 Reassigns benefits to 2 organizations
I20220602002858 NC Practitioner - Emergency Medicine 6305808015 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Louisville School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kinston Physicians Group PLLCGroup PAC ID 6204087919, 13 clinicians
Yadkin Emergency Physicians PLLCGroup PAC ID 3173875127, 23 clinicians
Jefferson Emergency Services PLLCGroup PAC ID 4880813047, 21 clinicians
Tarheel Emergency Group, PLLCGroup PAC ID 6709268576, 40 clinicians

Practice addresses (Care Compare)

100 Airport Rd
Kinston, NC 28501-1604
Phone (252) 522-7000

180 Parkwood Dr
Elkin, NC 28621-2430
Phone (336) 527-7000

200 Hospital Ave
Jefferson, NC 28640-9244
Phone (336) 846-7101

317 Western Blvd
Jacksonville, NC 28546-6338
Phone (910) 577-2345

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
87.33
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101243579VAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanglewood Park Physicians, PLLC Emergency Medicine CurrentSince Apr 20, 2022 Accepting new patients
Mep Health, LLC Emergency Medicine CurrentSince Jan 1, 2021 Accepting new patients
Dominion Health Medical Associates LTD CurrentSince Sep 1, 2011 Accepting new patients
Dominion Health Medical Assoc. Current Accepting new patients
Piedmont Triad Physicians, PLLC Emergency Medicine CurrentSince Apr 20, 2022 Accepting new patients
Dominion Health Medical Assoc CurrentSince Sep 1, 2011 Accepting new patients
Tarheel Emergency Group, PLLC Emergency Medicine CurrentSince Aug 15, 2022 Accepting new patients
Yadkin Emergency Physicians, PLLC Emergency Medicine CurrentSince Apr 20, 2022 Accepting new patients
Kinston Physicians Group, PLLC Emergency Medicine CurrentSince Aug 1, 2023 Accepting new patients
Jefferson Emergency Services, PLLC Emergency Medicine CurrentSince May 30, 2022 Accepting new patients
Kernersville Emergency Group, PLLC Emergency Medicine CurrentSince Apr 20, 2022 Accepting new patients
Venice Emergency Medical Associates PA Emergency Medicine Past Accepting new patients

Locations

6915 Village Medical Cir
Clemmons, NC 27012
Phone (336) 718-1680

180 Parkwood Dr
Elkin, NC 28621
Phone (336) 527-7000

317 Western Blvd
Jacksonville, NC 28546
Phone (910) 577-2240

200 Hospital Ave
Jefferson, NC 28640
Phone (336) 246-7101

1750 Kernersville Medical Pkwy
Kernersville, NC 27284
Phone (336) 564-4000

100 Airport Rd
Kinston, NC 28501
Phone (252) 522-7000

207 Old Lexington Rd
Thomasville, NC 27360
Phone (336) 472-2000

500 Martha Jefferson Dr
Charlottesvle, VA 22911
Phone (434) 654-7000

2204 Wilborn Ave
South Boston, VA 24592
Phone (434) 517-3100

2232 Wilborn Ave
Ste F
South Boston, VA 24592
Phone (434) 517-8095

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 12

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1720090376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 BROOK RUN RD",
            "city": "HALIFAX",
            "state": "VA",
            "postal_code": "245583004",
            "telephone_number": "434-476-2421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921645",
            "telephone_number": "434-517-3123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCUBBIN",
        "first_name": "JAMES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "VA",
            "license": "0101243579",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101243579",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1720090376",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Boston, VA

Sources for this page

Verify at the official NPI Registry.