Brunswick Cardiology
Organization Active NPI Specialist · Supply, NC
NPI 1821112673 · NPPES record last updated Sep 2, 2025
Key facts
- NPI
- 1821112673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- 35196 (NC)
- Legal business name
- BRUNSWICK CARDIOLOGY
- Practice address
- 20 Medical Campus Dr NW Ste 203
Supply, NC 28462-4094 - Phone
- (910) 755-7192
- Fax
- (910) 755-7194
- NPI assigned
- Mar 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Rebecca Little
- Title
- Office Assistant
- Phone
- (910) 755-7192
Practitioners 1
-
Jeffrey D Seder, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D1050261 | Brunswick Cardiology PC | Certificate of waiver | Jan 29, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250114003772 | NC | Part B Supplier - Clinic/Group Practice | 0143758425 |
Receives reassigned benefits from 1 practitioner Practice locations: Supply, NC |
National Provider Directory
Locations
10915 Bonita Beach Rd SE
#21
Bonita Springs, FL 34135
Phone (239) 992-8446
10915 Bonita Beach Rd SE
#216
Bonita Springs, FL 34135
Phone (239) 992-8446
20 Medical Campus Dr NW
Ste 203
Supply, NC 28462
Phone (910) 755-7181
Interoperability endpoints
- https://api.platform.athenahealth.com/13056/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 35196 | NC | Yes |
Addresses
Primary practice location
20 Medical Campus Dr NW Ste 203
Supply, NC 28462-4094
Mailing address
PO Box 427
Supply, NC 28462-0427
Phone (910) 755-7192
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8975177 | Medicaid | NC | |
| 561776208B | Other | NC | CIGNA HEALTHCARE |
| 75177 | Other | NC | BLUE CROSS BLUE SHIELD |
| 2207970 | Other | NC | UNITED HEALTHCARE |
Other names
- Brunswick Cardiology,PC
Other providers in Supply, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.