NPIMap

Organization Active NPI

Capeside Psychiatry, PLLC

  • Psychiatry Physician
  • Wilmington, NC
National Provider Identifier
1760891980
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
CAPESIDE PSYCHIATRY, PLLC
Practice address
311 Judges Rd Ste 4E
Wilmington, NC 28405-3655
Phone
(910) 791-6767
Fax
(910) 399-2190
NPI assigned
Aug 13, 2014
Last updated
Aug 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

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

Authorized official

Name
Amanda Dixon
Title
Credentialing Specialist
Phone
(910) 520-6756

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

311 Judges Rd Ste 4E
Wilmington, NC 28405-3655

Mailing address

311 Judges Rd Ste 4E
Wilmington, NC 28405-3655
Phone (910) 791-6767

Other practice location 1

102 Elizabeth St Ste D
Jacksonville, NC 28540-5681
Phone (910) 791-6767

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC, GA, VA, TN5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20141023001370 NC Part B Supplier - Clinic/Group Practice 5991926560 Receives reassigned benefits from 22 practitioners
Practice locations: Jacksonville, NC; Wilmington, NC
O20190607002038 SC Part B Supplier - Clinic/Group Practice 5991926560 Receives reassigned benefits from 4 practitioners
Practice locations: Ridgeland, SC
O20220510000949 GA Part B Supplier - Clinic/Group Practice 5991926560 Receives reassigned benefits from 6 practitioners
Practice locations: Blue Ridge, GA
O20220525000136 VA Part B Supplier - Clinic/Group Practice 5991926560 Receives reassigned benefits from 2 practitioners
Practice locations: Fredericksburg, VA
O20220720000099 TN Part B Supplier - Clinic/Group Practice 5991926560 Receives reassigned benefits from 3 practitioners
Practice locations: Roan Mountain, TN

National Provider Directory

National Provider Directory

Locations

146 Depot St
Ste 202
Blue Ridge, GA 30513
Phone (941) 780-4192

102 Elizabeth St
Ste D
Jacksonville, NC 28540

4889 Highway 17 Byp S
Myrtle Beach, SC 29577
Phone (843) 584-7011

11382 N Jacob Smart Blvd
Ste Cd
Ridgeland, SC 29936

8251 Highway 19 E
Ste 1
Roan Mountain, TN 37687

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754265600000",
    "number": "1760891980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 JUDGES RD STE 4E",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284053655",
            "telephone_number": "910-791-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 JUDGES RD STE 4E",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284053655",
            "telephone_number": "910-791-6767",
            "fax_number": "910-399-2190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 Elizabeth St Ste D",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285405681",
            "country_code": "US",
            "telephone_number": "910-791-6767",
            "fax_number": "910-399-2190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAPESIDE PSYCHIATRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-13",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "910-520-6756"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2025; 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.