NPIMap

Organization Active NPI

Carolinaeast Medical Center

  • Rehabilitation Hospital Unit
  • New Bern, NC
National Provider Identifier
1780641373
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
H0201 Issued in NC
Legal business name
CAROLINAEAST MEDICAL CENTER
Practice address
2000 Neuse Blvd
New Bern, NC 28560-3449
Phone
(252) 633-8640
Fax
(252) 636-5376
NPI assigned
Apr 27, 2006
Last updated
Jun 30, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROLINAEAST MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Authorized official

Name
Tammy Marie Sherron
Title
Cfo
Phone
(252) 633-8880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X H0201 NC Primary

Addresses

Primary practice location

2000 Neuse Blvd
New Bern, NC 28560-3449

Mailing address

2000 Neuse Blvd
New Bern, NC 28560-3449
Phone (252) 633-8640

Other identifiers 2

IdentifierTypeStateIssuer
3400131TMedicaidNC
00133OtherNCNC BLUE CROSS

Other names 1

  • CarolinaEast Rehabilitation Hospital Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081125000096 NC Part A Provider - Hospital 1557272564 Practice locations: New Bern, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780641373. Details of each certification follow.

Hospital certification: CCN 34T131

Legal name
CAROLINAEAST MEDICAL CENTER
Doing business as
CRAVEN REGIONAL MEDICAL CENTER
Organization structure
OtherNon-profit
Enrollment address
2000 Neuse Blvd
New Bern, NC 28560-3449
Hospital subgroups
Rehabilitation unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Carolinaeast Rehabilitation HospitalCCN 34T131 · All quality measures
Ownership
Government
Certified
Jul 1, 2022

National Provider Directory

National Provider Directory
Tax ID family
Prof Services CRMC11 organizations share this tax ID, including this one
Part of
Prof Services CRMC

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jeffrey Thomas Odham Individual Corporate OfficerBoard Member Jun 1, 2019
Dennis K Bucher Individual Corporate OfficerBoard Member Sep 16, 2021
Michael Carlton Smith Individual Operational/Managerial ControlCeo Jul 1, 2022
Kathleen M Gallman Individual Corporate OfficerBoard Member Sep 16, 2021
Thomas a Braaten Individual Corporate OfficerBoard Member Jun 1, 2019
Evelyn M Ackerman Individual W-2 Managing EmployeeBusiness Office Assistant Feb 21, 2022
Mary Beth Fennell Individual Corporate OfficerBoard Member Sep 6, 2023
Keith Wilkinson Bennert Individual Corporate OfficerBoard Member Jun 1, 2019
William Louis Cannon Individual Corporate OfficerBoard Member Sep 6, 2023
Terry Douglas Morris Individual Corporate OfficerBoard Member Sep 6, 2023
Tammy M Sherron Individual Corporate DirectorCfo Oct 22, 2010
Tahira Coble Copland Individual Corporate OfficerBoard Member Sep 6, 2023

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656547200000",
    "number": "1780641373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 NEUSE BLVD",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285603449",
            "telephone_number": "252-633-8640",
            "fax_number": "252-636-5376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 NEUSE BLVD",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285603449",
            "telephone_number": "252-633-8640",
            "fax_number": "252-636-5376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAEAST MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAEAST MEDICAL CENTER",
        "enumeration_date": "2006-04-27",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A",
        "authorized_official_last_name": "SHERRON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "252-633-8880"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "NC",
            "license": "H0201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3400131T",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC BLUE CROSS",
            "identifier": "00133",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CarolinaEast Rehabilitation Hospital",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CarolinaEast Rehabilitation Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New Bern, NC

Sources for this page

Verify at the official NPI Registry.