NPIMap

Organization Active NPI

Bladen Healthcare, LLC

  • Multi-Specialty Clinic/Center
  • Elizabethtown, NC
National Provider Identifier
1750557237
Registry record updated May 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
H0154 Issued in NC
Legal business name
BLADEN HEALTHCARE, LLC
Practice address
501 S Poplar St
Elizabethtown, NC 28337-9375
Phone
(910) 862-5179
Fax
(910) 862-5129
NPI assigned
May 5, 2008
Organization subpart
Yes
Parent organization
BLADEN HEALTHCARE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 5, 2008

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

Authorized official

Name
Mr. David Masterson
Title
Ceo
Phone
(910) 862-5178

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X H0154 NC Primary

Addresses

Primary practice location

501 S Poplar St
Elizabethtown, NC 28337-9375

Mailing address

501 S Poplar St
Elizabethtown, NC 28337-9375
Phone (910) 862-5179

Other identifiers 1

IdentifierTypeStateIssuer
8907624MedicaidNC

Other names 1

  • Cape Fear Valley - Bladen County Hospital (Cardiopulmonary Department) Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080617000314 NC Part B Supplier - Clinic/Group Practice 6800967969 Receives reassigned benefits from 173 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elizabethtown, NC; Whiteville, NC; Lumberton, NC; Dublin, NC; Clarkton, NC; Bladenboro, NC

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Bladen Healthcare LLC10 organizations share this tax ID, including this one
Part of
Bladen Healthcare LLC

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1209945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209945600000",
    "number": "1750557237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S POPLAR ST",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283379375",
            "telephone_number": "910-862-5179",
            "fax_number": "910-862-5129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S POPLAR ST",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283379375",
            "telephone_number": "910-862-5179",
            "fax_number": "910-862-5129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLADEN HEALTHCARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLADEN HEALTHCARE, LLC",
        "enumeration_date": "2008-05-05",
        "last_updated": "2008-05-05",
        "status": "A",
        "authorized_official_last_name": "MASTERSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-862-5178",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NC",
            "license": "H0154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8907624",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cape Fear Valley - Bladen County Hospital (Cardiopulmonary Department)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elizabethtown, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.