NPIMap

Organization Active NPI

Orthopaedics East & Sports Medicine Center, Inc.

  • Specialist
  • Greenville, NC
National Provider Identifier
1780655803
Registry record updated Sep 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ORTHOPAEDICS EAST & SPORTS MEDICINE CENTER, INC.
Practice address
810 W H Smith Blvd
Greenville, NC 27834-3763
Phone
(252) 757-2663
Fax
(252) 317-0829
NPI assigned
Jan 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2014

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

Authorized official

Name
Michael T. Brohawn
Title
Administrator
Phone
(252) 757-2663

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

810 W H Smith Blvd
Greenville, NC 27834-3763

Mailing address

810 W H Smith Blvd
Greenville, NC 27834-3763
Phone (252) 757-2663

Other identifiers 1

IdentifierTypeStateIssuer
690262UMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040209001244 NC Part B Supplier - Clinic/Group Practice 0749174019 Receives reassigned benefits from 34 practitioners
Practice locations: Greenville, NC
O20100930053780 NC DME Supplier - Physician - Orthopedic/Orthopedic Surgery 0749174019 Practice locations: Greenville, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410998400000",
    "number": "1780655803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 W H SMITH BLVD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278343763",
            "telephone_number": "252-757-2663",
            "fax_number": "252-317-0829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 W H SMITH BLVD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278343763",
            "telephone_number": "252-757-2663",
            "fax_number": "252-317-0829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPAEDICS EAST & SPORTS MEDICINE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-27",
        "last_updated": "2014-09-18",
        "status": "A",
        "authorized_official_last_name": "BROHAWN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "252-757-2663"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "690262U",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; 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.