NPIMap

Organization Active NPI

Whiteville Medical Associates PA

  • Family Medicine Physician
  • Whiteville, NC
National Provider Identifier
1902963937
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20979 Issued in NC
Legal business name
WHITEVILLE MEDICAL ASSOCIATES PA
Practice address
823 Jefferson St
Whiteville, NC 28472
Phone
(910) 642-6121
Fax
(910) 642-8457
NPI assigned
Jan 2, 2007
Last updated
Feb 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

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

Authorized official

Name
Dr. Henry W Traylor, MDNPI 1588677736
Title
President
Phone
(910) 642-6121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20979 NC Primary
Internal Medicine Physician 207R00000X 24304 NC
Pediatrics Physician 208000000X 39134 NC

Addresses

Primary practice location

823 Jefferson St
Whiteville, NC 28472

Mailing address

823 Jefferson St
PO Box 1528
Whiteville, NC 28472
Phone (910) 642-6121

Other identifiers 3

IdentifierTypeStateIssuer
NPA538OtherSCSOUTH CAROLINA MEDICAID
7902940MedicaidNC
CD8805OtherNCRAILROAD MEDICARE CLINIC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050714000929 NC Part B Supplier - Clinic/Group Practice 7719913318 Receives reassigned benefits from 7 practitioners
Practice locations: Whiteville, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0246111Whiteville Med Associates823 Jefferson Street, Whiteville, NC 28472AccreditationDec 22, 2027

National Provider Directory

National Provider Directory

Locations

14 Doctors Cir
Ste 3
Supply, NC 28462
Phone (910) 754-7075

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708560000000",
    "number": "1902963937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 JEFFERSON ST",
            "address_2": "PO BOX 1528",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "28472",
            "telephone_number": "910-642-6121",
            "fax_number": "910-642-8457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 JEFFERSON ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "28472",
            "telephone_number": "910-642-6121",
            "fax_number": "910-642-8457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITEVILLE MEDICAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A",
        "authorized_official_last_name": "TRAYLOR",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-642-6121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "20979",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "24304",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "39134",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTH CAROLINA MEDICAID",
            "identifier": "NPA538",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7902940",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE CLINIC",
            "identifier": "CD8805",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whiteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.

Verify at the official NPI Registry.