NPIMap

Organization Active NPI

Sampson Regional Medical Services LLC

  • Anesthesiology Physician
  • Clinton, NC
National Provider Identifier
1801086558
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SAMPSON REGIONAL MEDICAL SERVICES LLC
Practice address
607 Beaman St
Anesthesia Department
Clinton, NC 28328-2603
Phone
(910) 592-8511
NPI assigned
Jul 30, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Gerald T Heinzman Jr.
Title
Chief Financial Officer
Phone
(910) 592-8511

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NC
Anesthesiology Physician 207L00000X NC Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X NC

Addresses

Primary practice location

607 Beaman St
Anesthesia Department
Clinton, NC 28328-2603

Mailing address

PO Box 890235
Charlotte, NC 28289-0235
Phone (800) 919-1190

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070828000171 NC Part B Supplier - Clinic/Group Practice 5597857177 Receives reassigned benefits from 33 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, NC

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Sampson Reg Med Svcurology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

518 Beaman St
Clinton, NC 28328
Phone (910) 590-5312

603 Beaman St
Ste 200
Clinton, NC 28328
Phone (910) 592-8711

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1801086558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 890235",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282890235",
            "telephone_number": "800-919-1190",
            "fax_number": "706-737-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 BEAMAN ST",
            "address_2": "ANESTHESIA DEPARTMENT",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282603",
            "telephone_number": "910-592-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMPSON REGIONAL MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HEINZMAN",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "910-592-8511",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": null,
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 21, 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.