NPIMap

Individual provider Active NPI

Jamie L Fountain, M.D.

  • Internal Medicine Physician
  • Avon, NC
National Provider Identifier
1891826616
Registry record updated May 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C7-0003227 Issued in DE
Practice address
40894 Highway 12
Healtheast Outer Banks Medical Center
Avon, NC 27915
Phone
(252) 995-3073
NPI assigned
Mar 7, 2007
Last updated
May 22, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X C7-0003227 DE Primary
Pediatrics Physician 208000000X C7-0003227 DE

Addresses

Primary practice location

40894 Highway 12
Healtheast Outer Banks Medical Center
Avon, NC 27915

Mailing address

40894 Highway 12
PO Box 975
Avon, NC 27915

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090728000439 NC Practitioner - Internal MedicinePractitioner - Pediatric Medicine 1052464732 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of North Carolina at Chapel Hill School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Broad River RehabilitationGroup PAC ID 3375801350, 210 clinicians

Practice addresses (Care Compare)

40894 NC Hwy
Avon, NC 27915-9998
Phone (252) 995-3073

9120 Willow Ridge Rd
Charlotte, NC 28210-8313
Phone 82877452220027

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C7-0003227DEMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Dec 1, 2009 Accepting new patients
Outer Banks Professional Services, LLC Internal Medicine CurrentSince Jan 1, 2016 Accepting new patients
Heatheast Outer Banks Medical Center LLC Past Accepting new patients
Hatteras Village Medical Center, Inc. Past Accepting new patients

Locations

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

5565 N Croatan Hwy
Southrn Shore, NC 27949
Phone (252) 261-5800

Interoperability endpoints

  • Direct secure messaging: jfountain22748@direct.ecuhealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Outer Banks Health HospitalNags Head, NC, CCN 341324 Hospital Corporate Director May 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242950400000",
    "number": "1891826616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40894 HIGHWAY 12",
            "address_2": "PO BOX 975",
            "city": "AVON",
            "state": "NC",
            "postal_code": "27915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40894 HIGHWAY 12",
            "address_2": "HEALTHEAST OUTER BANKS MEDICAL CENTER",
            "city": "AVON",
            "state": "NC",
            "postal_code": "27915",
            "telephone_number": "252-995-3073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUNTAIN",
        "first_name": "JAMIE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2009-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "DE",
            "license": "C7-0003227",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "DE",
            "license": "C7-0003227",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon, NC

Sources for this page

Verify at the official NPI Registry.