NPIMap

Organization Active NPI

Sampson Regional Professional Services LLC

Doing business as John Roberts MD Gynecology

  • Gynecology Physician
  • Clinton, NC
National Provider Identifier
1760706154
Registry record updated May 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
Legal business name
SAMPSON REGIONAL PROFESSIONAL SERVICES LLC
Doing business as
John Roberts MD Gynecology
Practice address
603 Beaman St
Suite 501
Clinton, NC 28328-2650
Phone
(910) 590-8000
Fax
(910) 590-8001
NPI assigned
Mar 15, 2010
Last updated
May 1, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2013

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) 592-8511

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VG0400X Primary

Addresses

Primary practice location

603 Beaman St
Suite 501
Clinton, NC 28328-2650

Mailing address

603 Beaman St
Suite 501
Clinton, NC 28328-2650
Phone (910) 590-8000

Other identifiers 3

IdentifierTypeStateIssuer
8972188MedicaidNC
P00898016OtherNCRR MEDICARE
72188OtherNCBCBS

Other names 1

  • John Roberts MD Gynecology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091014000771 NC Part B Supplier - Clinic/Group Practice 6406992817 Receives reassigned benefits from 33 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, NC; Roseboro, NC; Newton Grove, NC

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Sampson Regional Professional Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1268611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367366400000",
    "number": "1760706154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 BEAMAN ST",
            "address_2": "SUITE 501",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282650",
            "telephone_number": "910-590-8000",
            "fax_number": "910-590-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 BEAMAN ST",
            "address_2": "SUITE 501",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282650",
            "telephone_number": "910-590-8000",
            "fax_number": "910-590-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMPSON REGIONAL PROFESSIONAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-15",
        "last_updated": "2013-05-01",
        "status": "A",
        "authorized_official_last_name": "MASTERSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-592-8511",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8972188",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00898016",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "72188",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "John Roberts MD Gynecology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; 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.