NPIMap

Organization Active NPI

Catawba Valley Medical Group, Inc

Doing business as Catawba Valley Family Care - Catawba

  • Family Medicine Physician
  • Catawba, NC
National Provider Identifier
1790062362
Registry record updated Jul 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CATAWBA VALLEY MEDICAL GROUP, INC
Doing business as
Catawba Valley Family Care - Catawba
Practice address
200 Rosenwald School St SW
Catawba, NC 28609-8896
Phone
(828) 241-2377
Fax
(828) 241-2678
NPI assigned
Nov 10, 2011
Last updated
Jul 9, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
CATAWBA VALLEY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2013

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

Authorized official

Name
David J Boone
Title
Sr VP of Finance/Cfo
Phone
(828) 326-3809

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

200 Rosenwald School St SW
Catawba, NC 28609-8896

Mailing address

200 Rosenwald School St SW
Catawba, NC 28609-8896
Phone (828) 241-2377

Other identifiers 2

IdentifierTypeStateIssuer
1790062362MedicaidNC
026CPOtherNCNC BCBS

Other names 1

  • CATAWBA VALLEY FAMILY CARE - CATAWBA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120420000030 NC Part B Supplier - Clinic/Group Practice 6305007279 Receives reassigned benefits from 162 practitioners
34 other NPIs on this enrollment
Practice locations: Hickory, NC; Lenoir, NC; Maiden, NC; Newton, NC; Sherrills Ford, NC; Sherrills FRD, NC; Taylorsville, NC; Claremont, NC…

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 29

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

View all 29

National Provider Directory

National Provider Directory
Part of
Catawba Memorial ER Phy

Locations

200 Rosenwald School St
Catawba, NC 28609
Phone (828) 241-2377

Practitioners & affiliated clinicians

Practitioners 174

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 174

NPI Registry JSON

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

{
    "created_epoch": "1320883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373328000000",
    "number": "1790062362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 ROSENWALD SCHOOL ST SW",
            "city": "CATAWBA",
            "state": "NC",
            "postal_code": "286098896",
            "telephone_number": "828-241-2377",
            "fax_number": "828-241-2678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ROSENWALD SCHOOL ST SW",
            "city": "CATAWBA",
            "state": "NC",
            "postal_code": "286098896",
            "telephone_number": "828-241-2377",
            "fax_number": "828-241-2678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CATAWBA VALLEY MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CATAWBA VALLEY MEDICAL CENTER",
        "enumeration_date": "2011-11-10",
        "last_updated": "2013-07-09",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SR VP OF FINANCE/CFO",
        "authorized_official_telephone_number": "828-326-3809"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790062362",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC BCBS",
            "identifier": "026CP",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CATAWBA VALLEY FAMILY CARE - CATAWBA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Catawba, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; 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.