NPIMap

Organization Active NPI

Port Health Services

  • Counselor
  • Kinston, NC
National Provider Identifier
1720145535
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
PORT HEALTH SERVICES
Practice address
2901 N Herritage St Ste B
Kinston, NC 28501-1594
Phone
(252) 233-2383
Fax
(252) 523-3148
NPI assigned
Jan 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Authorized official

Name
Brett Beavers
Title
Credentialing Manager
Phone
(919) 210-7661

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

2901 N Herritage St Ste B
Kinston, NC 28501-1594

Mailing address

4300 Sapphire CT Ste 110
Greenville, NC 27834-9079
Phone (252) 830-7540

Other identifiers 1

IdentifierTypeStateIssuer
8301050MedicaidNC

Other names 1

  • PORT Human Services Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050726001211 NC Part B Supplier - Clinic/Group Practice 5193752681 Receives reassigned benefits from 43 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wilmington, NC; Whiteville, NC; Washington, NC; Rocky Mount, NC; New Bern, NC; Nags Head, NC; Morehead City, NC; Kinston, NC…

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1720145535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 SAPPHIRE CT STE 110",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278349079",
            "telephone_number": "252-830-7540",
            "fax_number": "252-413-0932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 N HERRITAGE ST STE B",
            "city": "KINSTON",
            "state": "NC",
            "postal_code": "285011594",
            "telephone_number": "252-233-2383",
            "fax_number": "252-523-3148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "BEAVERS",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "919-210-7661"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301050",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PORT Human Services",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "PORT Human Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Kinston, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.