NPIMap

Organization Active NPI

Easter Seals Ucp North Carolina & Virgiinia, Inc.

  • Community/Behavioral Health Agency
  • Wilmington, NC
National Provider Identifier
1871647503
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EASTER SEALS UCP NORTH CAROLINA & VIRGIINIA, INC.
Practice address
1410 Commonwealth Dr Ste 103a
Wilmington, NC 28403-0377
Phone
(910) 790-5921
Fax
(910) 794-1036
NPI assigned
Jan 22, 2007
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Brett Beavers
Title
Credentialing Manager
Phone
(919) 210-7661

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X Primary
Foster Care Agency 253J00000X

Addresses

Primary practice location

1410 Commonwealth Dr Ste 103a
Wilmington, NC 28403-0377

Mailing address

5171 Glenwood Ave
Suite 400
Raleigh, NC 27612-3266
Phone (919) 783-8898

Other practice location 1

5040 New Centre Drive
Ste F
Wilmington, NC 28403-1343
Phone (910) 790-5921

Other practice location 2

4130 Oleander Dr Ste 100
Wilmington, NC 28403-6844
Phone (910) 794-1036

Other identifiers 7

IdentifierTypeStateIssuer
8303044MedicaidNC
8301006IMedicaidNC
8301006BMedicaidNC
8301006AMedicaidNC
8303044AMedicaidNC
8301006HMedicaidNC
8301006GMedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101105000534 NC Part B Supplier - Clinic/Group Practice 7618161407 Receives reassigned benefits from 79 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Raleigh, NC; Jacksonville, NC; New Bern, NC; Nags Head, NC; Mount Airy, NC; Morganton, NC; Morehead City, NC; Kinston, NC…

National Provider Directory

National Provider Directory
Tax ID family
Easter Seals Ucp North Carolina224 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

5040 New Centre Dr
Ste F
Wilmington, NC 28403
Phone (910) 343-8347

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1871647503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5171 GLENWOOD AVE",
            "address_2": "SUITE 400",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123266",
            "telephone_number": "919-783-8898",
            "fax_number": "919-782-5486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 COMMONWEALTH DR STE 103A",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284030377",
            "telephone_number": "910-790-5921",
            "fax_number": "910-794-1036"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5040 New Centre Drive",
            "address_2": "Ste F",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284031343",
            "country_code": "US",
            "telephone_number": "910-790-5921",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4130 Oleander Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284036844",
            "country_code": "US",
            "telephone_number": "910-794-1036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EASTER SEALS UCP NORTH CAROLINA & VIRGIINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "BEAVERS",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "919-210-7661"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8303044",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301006I",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301006B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301006A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8303044A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301006H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301006G",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.