NPIMap

Organization Active NPI

Centennial Housing & Community Services Corporation

Doing business as Washington Regional Medical Center

  • Emergency Medicine Physician
  • Plymouth, NC
National Provider Identifier
1902412729
Registry record updated Jun 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
CENTENNIAL HOUSING & COMMUNITY SERVICES CORPORATION
Doing business as
Washington Regional Medical Center
Practice address
958 US Highway 64 E
Plymouth, NC 27962-9216
Phone
(252) 793-4135
Fax
(252) 793-7740
NPI assigned
Sep 17, 2020
Last updated
Jun 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2022

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

Authorized official

Name
Frank T Avignone IV
Title
Ceo
Phone
(214) 502-9624

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

958 US Highway 64 E
Plymouth, NC 27962-9216

Mailing address

7920 Belt Line Rd Ste 215
Dallas, TX 75254-8155
Phone (214) 210-9095

Other names 1

  • Washington Regional Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201102001412 NC Part B Supplier - Clinic/Group Practice 3779993837 Receives reassigned benefits from 25 practitioners
Practice locations: Plymouth, NC

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655424000000",
    "number": "1902412729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7920 BELT LINE RD STE 215",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752548155",
            "telephone_number": "214-210-9095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "958 US HIGHWAY 64 E",
            "city": "PLYMOUTH",
            "state": "NC",
            "postal_code": "279629216",
            "telephone_number": "252-793-4135",
            "fax_number": "252-793-7740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL HOUSING & COMMUNITY SERVICES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-17",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A",
        "authorized_official_last_name": "AVIGNONE",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-502-9624",
        "authorized_official_name_suffix": "IV"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Washington Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Washington Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.