NPIMap

Organization Active NPI

Pride in North Carolina, LLC

  • Community/Behavioral Health Agency
  • Jacksonville, NC
National Provider Identifier
1821136581
Registry record updated Oct 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PRIDE IN NORTH CAROLINA, LLC
Practice address
110-B Branchwood Drive
Jacksonville, NC 28546-5900
Phone
(910) 938-9833
Fax
(910) 938-9835
NPI assigned
Feb 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2017

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

Authorized official

Name
Mr. Jason Rutski
Title
Director of Business Operations
Phone
(910) 452-1460

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

110-B Branchwood Drive
Jacksonville, NC 28546-5900

Mailing address

231 Commerce St
Greenville, NC 27858-5029
Phone (252) 321-8080

Other identifiers 3

IdentifierTypeStateIssuer
8300338BMedicaidNC
8300338GMedicaidNC
8300338MedicaidNC

Other names 1

  • Pride in North Carolina, Inc Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050711000558 NC Part B Supplier - Clinic/Group Practice 9638105869 Receives reassigned benefits from 70 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Raleigh, NC; Wilson, NC; Wilmington, NC; Smithfield, NC; Jacksonville, NC; Greenville, NC; Goldsboro, NC; Fayetteville, NC…

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

350 Holly Hill Ln
Ste B
Burlington, NC 27215
Phone (336) 586-0647

2815 S Church St
Burlington, NC 27215
Phone (336) 586-0647

119 SW Maynard Rd
Ste 209
Cary, NC 27511
Phone (919) 461-4913

905 Halstead Blvd
Ste 21
Elizabeth City, NC 27909
Phone (252) 331-0322

1400 W Church St
Elizabeth City, NC 27909
Phone (252) 231-0322

101 E Victoria Ct
Ste A
Greenville, NC 27858
Phone (252) 321-8080

7610 Falls of Neuse Rd
Ste 290
Raleigh, NC 27615
Phone (919) 321-9702

1319 N Brightleaf Blvd
Ste F
Smithfield, NC 27577
Phone (919) 934-1312

4106 Shipyard Blvd
Wilmington, NC 28403
Phone (910) 769-1785

2416 Bedgood Dr SW
Wilson, NC 27893
Phone (252) 265-9200

3456 Airport Blvd NW
#A
Wilson, NC 27896
Phone (252) 265-9200

Practitioners & affiliated clinicians

Practitioners 108

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

View all 108

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507075200000",
    "number": "1821136581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 COMMERCE ST",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278585029",
            "telephone_number": "252-321-8080",
            "fax_number": "252-321-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110-B BRANCHWOOD DRIVE",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465900",
            "telephone_number": "910-938-9833",
            "fax_number": "910-938-9835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIDE IN NORTH CAROLINA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2017-10-04",
        "status": "A",
        "authorized_official_last_name": "RUTSKI",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "910-452-1460",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300338B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300338G",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300338",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pride in North Carolina, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2017; 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.