Active NPI
County of Brunswick
- State or Local Public Health Clinic/Center
- Bolivia, NC
National Provider Identifier
1841248622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- State or Local Public Health Clinic/Center
- Legal business name
- COUNTY OF BRUNSWICK
- Practice address
- 25 Courthouse Dr. NE
BLG a
Bolivia, NC 28422-0009 - Phone
- (910) 253-2250
- Fax
- (910) 253-2370
- NPI assigned
- May 4, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Barbara Randolph Jackson
- Title
- Management Support Director
- Phone
- (910) 253-2284
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | NC | ||
| Community Health Clinic/Center | 261QC1500X | NC | ||
| Non-Surgical Family Planning Clinic/Center | 261QF0050X | NC | ||
| State or Local Public Health Clinic/Center | 261QP0905X | NC | Primary | |
| Primary Care Clinic/Center | 261QP2300X | NC | ||
| Clinical Medical Laboratory | 291U00000X | 34D0245906 | NC | |
| Clinic Pharmacy | 3336C0002X | 04210 | NC |
Addresses
Primary practice location
25 Courthouse Dr. NE
BLG a
Bolivia, NC 28422-0009
Mailing address
PO Box 9
Bolivia, NC 28422-0009
Phone (910) 253-2284
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3404476 | Medicaid | NC | |
| 194741 | Other | NC | MEDCOST |
| 070900 | Other | NC | BLUE CROSS BLUE SHIELD |
| ========= | Other | NC | CAPE |
| 3404310 | Medicaid | NC | |
| 80888 | Other | NC | CIGNA |
| ========= | Other | NC | OTHER INSURANCES |
| ========= | Other | NC | UNITED HEALTHCARE |
Other names 1
- Brunswick County Health Services
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050131000387 | NC | Part B Supplier - Clinic/Group Practice | 3274438296 |
Receives reassigned benefits from 4 practitioners 1 other NPI on this enrollment Practice locations: Bolivia, 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 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- State or Local Public Health Clinic/Center
- Bolivia, NC
- NPI 1356498794
O20050131000387
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2322571 | Brunswick County Health Services | Certificate of waiver | Apr 22, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- County of Brunswick
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
- Registered Dietitian
- Bolivia, NC
- NPI 1043599376
-
- Case Management Agency
- Bolivia, NC
- NPI 1265602304
-
- Nursing Care Agency
- Bolivia, NC
- NPI 1548391972
-
- Land Ambulance
- Bolivia, NC
- NPI 1831146471
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Obstetrics & Gynecology Nurse Practitioner
- Bolivia, NC
- NPI 1336144518
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1707696000000",
"number": "1841248622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9",
"city": "BOLIVIA",
"state": "NC",
"postal_code": "284220009",
"telephone_number": "910-253-2284",
"fax_number": "102-532-3709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 COURTHOUSE DR. NE",
"address_2": "BLG A",
"city": "BOLIVIA",
"state": "NC",
"postal_code": "284220009",
"telephone_number": "910-253-2250",
"fax_number": "910-253-2370"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COUNTY OF BRUNSWICK",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-04",
"last_updated": "2024-02-12",
"certification_date": "2024-02-09",
"status": "A",
"authorized_official_last_name": "JACKSON",
"authorized_official_first_name": "BARBARA",
"authorized_official_middle_name": "RANDOLPH",
"authorized_official_title_or_position": "MANAGEMENT SUPPORT DIRECTOR",
"authorized_official_telephone_number": "910-253-2284",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": "NC",
"license": null,
"primary": false
},
{
"code": "261QC1500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Community Health",
"state": "NC",
"license": null,
"primary": false
},
{
"code": "261QF0050X",
"taxonomy_group": "",
"desc": "Clinic/Center, Family Planning, Non-Surgical",
"state": "NC",
"license": null,
"primary": false
},
{
"code": "261QP0905X",
"taxonomy_group": "",
"desc": "Clinic/Center, Public Health, State or Local",
"state": "NC",
"license": null,
"primary": true
},
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": "NC",
"license": null,
"primary": false
},
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "NC",
"license": "34D0245906",
"primary": false
},
{
"code": "3336C0002X",
"taxonomy_group": "",
"desc": "Pharmacy, Clinic Pharmacy",
"state": "NC",
"license": "04210",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3404476",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "194741",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "070900",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPE",
"identifier": "=========",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3404310",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "80888",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER INSURANCES",
"identifier": "=========",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "=========",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Brunswick County Health Services",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Brunswick County Health Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bolivia, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.