Individual provider Active NPI

Robert J Stillwell Jr., ACNP

  • Acute Care Nurse Practitioner
  • Greenville, NC
National Provider Identifier
1770068397
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
5011003 Issued in NC
Practice address
2100 Stantonsburg Rd
Greenville, NC 27834-2818
Phone
(252) 847-4100
NPI assigned
Sep 28, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2100X 5011003 NC Primary

Addresses

Primary practice location

2100 Stantonsburg Rd
Greenville, NC 27834-2818

Mailing address

4218 Smithson CT
Raleigh, NC 27616-9794
Phone (908) 255-9647

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181211003810 NC Practitioner - Nurse Practitioner 9335483775 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Practice addresses (Care Compare)

2100 Stantonsburg Rd
Greenville, NC 27834-2818
Phone (252) 847-1757

401 A N Main St
Kenansville, NC 28349-8801
Phone (910) 296-0941

401 N Main St
Kenansville, NC 28349-8801
Phone (910) 296-0941

417 N Main St
Kenansville, NC 28349-8801
Phone (910) 296-8080

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Health System, Inc. CurrentSince Mar 3, 2021 Accepting new patients
Vidant Medical Group LLC Multi-Specialty CurrentSince Sep 30, 2018 Accepting new patients
Vidant Medical Group LLC CurrentSince Sep 30, 2018 Accepting new patients
Duke University Health System, Inc. Multi-Specialty CurrentSince Mar 3, 2021 Accepting new patients

Locations

5213 S Alston Ave
Durham, NC 27713
Phone (919) 620-4700

2301 Erwin Rd
Durham, NC 27705
Phone (919) 668-0289

2100 Erwin Rd
Durham, NC 27705
Phone (919) 648-8111

2100 Stantonsburg Rd
Greenville, NC 27834
Phone (252) 744-3229

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1770068397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4218 SMITHSON CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276169794",
            "telephone_number": "908-255-9647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 STANTONSBURG RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342818",
            "telephone_number": "252-847-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STILLWELL",
        "first_name": "ROBERT",
        "middle_name": "J",
        "name_suffix": "Jr.",
        "credential": "ACNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-28",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NC",
            "license": "5011003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.