NPIMap

Organization Active NPI

Sampson Regional Professional Services, LLC

Doing business as Sampson Surgical Services

  • Surgery Physician
  • Clinton, NC
National Provider Identifier
1760744361
Registry record updated Aug 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SAMPSON REGIONAL PROFESSIONAL SERVICES, LLC
Doing business as
Sampson Surgical Services
Practice address
607 Beaman Street
Clinton, NC 28328-2603
Phone
(910) 592-8511
NPI assigned
Jun 11, 2012
Last updated
Aug 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2017

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

Authorized official

Name
Mr. Hunter Balltzglier
Title
Director
Phone
(910) 590-8755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

607 Beaman Street
Clinton, NC 28328-2603

Mailing address

607 Beaman St.
Clinton, NC 28328-2603

Other names 1

  • Sampson Surgical Services 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 Services LLC6 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.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

603 Beaman St
Ste 100
Clinton, NC 28328
Phone (910) 590-0027

603 Beaman St
Ste 300
Clinton, NC 28328
Phone (910) 596-6113

603 Beaman St
Ste 501
Clinton, NC 28328
Phone (910) 299-7448

603 Beaman St
Ste 502
Clinton, NC 28328
Phone (910) 590-8050

301 Main St
Newton Grove, NC 28366
Phone (910) 594-0003

304 W NC Highway 24
Roseboro, NC 28382
Phone (910) 525-5848

Practitioners & affiliated clinicians

Practitioners 33

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.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502236800000",
    "number": "1760744361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 BEAMAN ST.",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 BEAMAN STREET",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282603",
            "telephone_number": "910-592-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMPSON REGIONAL PROFESSIONAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-11",
        "last_updated": "2017-08-09",
        "status": "A",
        "authorized_official_last_name": "BALLTZGLIER",
        "authorized_official_first_name": "HUNTER",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-590-8755",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sampson Surgical Services",
            "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 Aug 9, 2017; 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.