NPIMap

Organization Active NPI

Crystal Coast Pain Management Center, PLLC

  • Pain Medicine (Anesthesiology) Physician
  • New Bern, NC
National Provider Identifier
1790747988
Registry record updated Jul 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
CRYSTAL COAST PAIN MANAGEMENT CENTER, PLLC
Practice address
2111 Neuse Blvd. Suite J
New Bern, NC 28560
Phone
(252) 636-0300
Fax
(252) 636-0335
NPI assigned
Apr 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2018

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

Authorized official

Name
Dr. Kirk Edward Harum, M.D.NPI 1013904614
Title
Owner/ Physician
Phone
(252) 636-0300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP2900X Primary

Addresses

Primary practice location

2111 Neuse Blvd. Suite J
New Bern, NC 28560

Mailing address

2111 Neuse Blvd. Suite J
New Bern, NC 28560-4317
Phone (252) 636-0300

Other identifiers 1

IdentifierTypeStateIssuer
8940362MedicaidNC

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040616001590 NC Part B Supplier - Clinic/Group Practice 7315921236 Receives reassigned benefits from 17 practitioners
Practice locations: Jacksonville, NC; Morehead City, NC; New Bern, NC
O20180731000293 NC DME Supplier - Physician - General Practice 7315921236 Practice locations: New Bern, NC

National Provider Directory

National Provider Directory

Locations

57 Office Park Dr
Ste 200
Jacksonville, NC 28546

54 Office Park Dr
Jacksonville, NC 28546

34 Office Park Dr
Ste 200
Jacksonville, NC 28546

2111 Neuse Blvd
New Bern, NC 28560
Phone (252) 636-0300

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532476800000",
    "number": "1790747988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 NEUSE BLVD. SUITE J",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285604317",
            "telephone_number": "252-636-0300",
            "fax_number": "252-636-0335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 NEUSE BLVD. SUITE J",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "28560",
            "telephone_number": "252-636-0300",
            "fax_number": "252-636-0335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL COAST PAIN MANAGEMENT CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2018-07-25",
        "status": "A",
        "authorized_official_last_name": "HARUM",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER/ PHYSICIAN",
        "authorized_official_telephone_number": "252-636-0300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8940362",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Bern, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; 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.