Organization Active NPI

County of Cumberland

  • Psychiatry Physician
  • Fayetteville, NC
National Provider Identifier
1750412516
Registry record updated Jan 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
COUNTY OF CUMBERLAND
Practice address
1724 Roxie Ave
Fayetteville, NC 28304-1623
Phone
(910) 323-0601
Fax
(910) 323-0096
NPI assigned
Mar 7, 2007
Last updated
Jan 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2008

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

Authorized official

Name
Ms. Densie D Lucas
Title
Assistant Area Director
Phone
(910) 323-0601

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X MHL-026-107 NC
Substance Abuse Rehabilitation Facility 324500000X MHL-026-107 NC
Respite Care 385H00000X
Psychiatry Physician 2084P0800X Primary
Child & Adolescent Psychiatry Physician 2084P0804X

Addresses

Primary practice location

1724 Roxie Ave
Fayetteville, NC 28304-1623

Mailing address

PO Box 3069
Fayetteville, NC 28302-3069
Phone (910) 323-0601

Other identifiers 2

IdentifierTypeStateIssuer
5901594OtherNCPHYSICIAN GROUP NUMBER
6005769OtherNCMULTI-SPECIALTY GROUP MUN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040511001437 NC Part B Supplier - Clinic/Group Practice 8921097163 Receives reassigned benefits from 5 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fayetteville, NC

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200441600000",
    "number": "1750412516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3069",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283023069",
            "telephone_number": "910-323-0601",
            "fax_number": "910-323-0096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1724 ROXIE AVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283041623",
            "telephone_number": "910-323-0601",
            "fax_number": "910-323-0096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF CUMBERLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2008-01-16",
        "status": "A",
        "authorized_official_last_name": "LUCAS",
        "authorized_official_first_name": "DENSIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ASSISTANT AREA DIRECTOR",
        "authorized_official_telephone_number": "910-323-0601",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-026-107",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NC",
            "license": "MHL-026-107",
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN GROUP NUMBER",
            "identifier": "5901594",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTI-SPECIALTY GROUP MUN",
            "identifier": "6005769",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; 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.