NPIMap

Organization Active NPI

Clinton Medical Clinic, Inc.

Doing business as Clinton Medical Clinic

  • General Practice Physician
  • Clinton, NC
National Provider Identifier
1780629154
Registry record updated Jul 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CLINTON MEDICAL CLINIC, INC.
Doing business as
Clinton Medical Clinic
Practice address
403 Fairview St
Clinton, NC 28328-2399
Phone
(910) 592-6011
Fax
(910) 592-0811
NPI assigned
Jun 18, 2006
Last updated
Jul 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2022

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

Authorized official

Name
Matthew Q. Robinson, MBA
Title
Practice Administrator
Phone
(910) 590-0619

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NC
Nurse Practitioner 363L00000X NC
Family Nurse Practitioner 363LF0000X NU
Pediatric Nurse Practitioner 363LP0200X NU
Family Medicine Physician 207Q00000X NC
Pediatrics Physician 208000000X NC
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

403 Fairview St
Clinton, NC 28328-2399

Mailing address

403 Fairview St
Clinton, NC 28328-2399
Phone (910) 592-6011

Other practice location 1

404 Fairview St
Clinton, NC 28328-2312
Phone (910) 592-6011

Other identifiers 4

IdentifierTypeStateIssuer
8382628NOtherNCAETNA
8901340MedicaidNC
01340OtherNCNCBLUE CROSS BLUE SHIELD
00321919MedicaidNC

Other names 1

  • Clinton Medical Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address clintonmedicalclinic@cmci.allscriptsdirect.net Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040831001347 NC Part B Supplier - Clinic/Group Practice 6406821628 Receives reassigned benefits from 18 practitioners
Practice locations: Clinton, NC

National Provider Directory

National Provider Directory

Locations

404 Fairview St
Clinton, NC 28328
Phone (910) 592-6011

Interoperability endpoints

  • Direct secure messaging: adaconway@cmci.allscriptsdirect.net
  • Direct secure messaging: arthurapolinario@cmci.allscriptsdirect.net
  • Direct secure messaging: ashleytuttle@cmci.allscriptsdirect.net
  • Direct secure messaging: carriegreen@cmci.allscriptsdirect.net
  • Direct secure messaging: clintonmedicalclinic@cmci.allscriptsdirect.net
  • Direct secure messaging: collinjohnson@cmci.allscriptsdirect.net
  • Direct secure messaging: crystalgillis@cmci.allscriptsdirect.net
  • Direct secure messaging: gilbertpalmer@cmci.allscriptsdirect.net
  • Direct secure messaging: gingermccullen@cmci.allscriptsdirect.net
  • Direct secure messaging: hayleybrott@cmci.allscriptsdirect.net
  • Direct secure messaging: hilarymccullen@cmci.allscriptsdirect.net
  • Direct secure messaging: jamieweiner@cmci.allscriptsdirect.net
  • Direct secure messaging: johnnewton@cmci.allscriptsdirect.net
  • Direct secure messaging: kenyang@cmci.allscriptsdirect.net
  • Direct secure messaging: laurenaves@cmci.allscriptsdirect.net
  • Direct secure messaging: lawrencewatts@cmci.allscriptsdirect.net
  • Direct secure messaging: seththomas@cmci.allscriptsdirect.net
  • Direct secure messaging: sharrymalpass@cmci.allscriptsdirect.net
  • Direct secure messaging: tanyatodd@cmci.allscriptsdirect.net
  • Direct secure messaging: taramarr-carter@cmci.allscriptsdirect.net

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657238400000",
    "number": "1780629154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 FAIRVIEW ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282399",
            "telephone_number": "910-592-6011",
            "fax_number": "910-592-0811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 FAIRVIEW ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282399",
            "telephone_number": "910-592-6011",
            "fax_number": "910-592-0811"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "404 Fairview St",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "NC",
            "postal_code": "283282312",
            "country_code": "US",
            "telephone_number": "910-592-6011",
            "fax_number": "910-592-0819",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLINTON MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "Q.",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "910-590-0619",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "8382628N",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901340",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCBLUE CROSS BLUE SHIELD",
            "identifier": "01340",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00321919",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "clintonmedicalclinic@cmci.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Clinic DM Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Message",
            "address_1": "403 Fairview St",
            "city": "Clinton",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283282399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Clinton Medical Clinic",
            "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 Jul 8, 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.