NPIMap

Organization Active NPI

Southeastern Regional Physician Services

  • Clinic/Center
  • Lumberton, NC
National Provider Identifier
1780202093
Registry record updated May 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
Practice address
4901 Dawn Dr Ste 3300
Lumberton, NC 28360-8288
Phone
(910) 671-5410
Fax
(910) 735-8695
NPI assigned
Jul 13, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2022

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

Authorized official

Name
Charles Thomas Johnson
Title
Cro
Phone
(910) 671-5083

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

4901 Dawn Dr Ste 3300
Lumberton, NC 28360-8288

Mailing address

2002 N Cedar St Ste B
Lumberton, NC 28358-3926
Phone (910) 272-3048

Other names 1

  • Southeastern Health Endocrinology Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100106000556 NC Part B Supplier - Clinic/Group Practice 7012058548 Receives reassigned benefits from 140 practitioners
31 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pembroke, NC; Lumberton, NC; Hope Mills, NC

Other NPIs on the same Medicare enrollment 31

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

View all 31

National Provider Directory

National Provider Directory

Locations

725 Oakridge Blvd
Ste A2
Lumberton, NC 28358

NPI Registry JSON

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

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652140800000",
    "number": "1780202093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 N CEDAR ST STE B",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283583926",
            "telephone_number": "910-272-3048",
            "fax_number": "910-738-3764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 DAWN DR STE 3300",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283608288",
            "telephone_number": "910-671-5410",
            "fax_number": "910-735-8695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN REGIONAL PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-13",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CRO",
        "authorized_official_telephone_number": "910-671-5083"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern Health Endocrinology Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southeastern Health Endocrinology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lumberton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; 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.