NPIMap

Organization Active NPI

Southeastern Regional Medical Center

Doing business as Gibson CC

  • Surgical Oncology Physician
  • Lumberton, NC
National Provider Identifier
1912337684
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Oncology PhysicianTaxonomy code 2086X0206X
Legal business name
SOUTHEASTERN REGIONAL MEDICAL CENTER
Doing business as
Gibson CC
Practice address
1200 Pine Run Dr
Lumberton, NC 28358-2180
Phone
(910) 737-6418
Fax
(910) 671-5732
NPI assigned
Nov 18, 2013
Last updated
Sep 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

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

Authorized official

Name
Charles Thomas Johnson
Title
Chief Reimbursment Officer
Phone
(910) 671-5083

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X
Surgical Oncology Physician 2086X0206X Primary

Addresses

Primary practice location

1200 Pine Run Dr
Lumberton, NC 28358-2180

Mailing address

300 W 27TH St
Lumberton, NC 28358-3075
Phone (910) 671-5290

Other identifiers 1

IdentifierTypeStateIssuer
1912337684MedicaidNC

Other names 1

  • Gibson CC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000154 NC Part B Supplier - Clinic/Group Practice 7315857141 Receives reassigned benefits from 71 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lumberton, NC

Other NPIs on the same Medicare enrollment 41

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 41

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1384732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1912337684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W 27TH ST",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283583075",
            "telephone_number": "910-671-5290",
            "fax_number": "910-671-8515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 PINE RUN DR",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283582180",
            "telephone_number": "910-737-6418",
            "fax_number": "910-671-5732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-18",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CHIEF REIMBURSMENT OFFICER",
        "authorized_official_telephone_number": "910-671-5083"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912337684",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gibson CC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gibson CC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lumberton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.