NPIMap

Organization Active NPI

Stanly Family Care Clinic PA

  • Family Medicine Physician
  • Albemarle, NC
National Provider Identifier
1942255708
Registry record updated Mar 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
24425 Issued in NC
Legal business name
STANLY FAMILY CARE CLINIC PA
Practice address
1007 N 6TH St
Albemarle, NC 28001-3551
Phone
(704) 983-3121
Fax
(704) 983-4659
NPI assigned
May 23, 2006
Last updated
Mar 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2008

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

Authorized official

Name
Dr. Eric Merriman Johnsen, M.D.NPI 1578542759
Title
President
Phone
(704) 983-3121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 24425 NC Primary

Addresses

Primary practice location

1007 N 6TH St
Albemarle, NC 28001-3551

Mailing address

1007 N 6TH St
Albemarle, NC 28001-3551
Phone (704) 983-3121

Other identifiers 4

IdentifierTypeStateIssuer
890243CMedicaidNC
46027OtherNCBCBS IND.
0243COtherNCBCBS GROUP
080077493OtherNCRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

1007 N 6th St
Albemarle, NC 28001
Phone (336) 625-8410

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": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1942255708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 N 6TH ST",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280013551",
            "telephone_number": "704-983-3121",
            "fax_number": "704-983-4659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 N 6TH ST",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280013551",
            "telephone_number": "704-983-3121",
            "fax_number": "704-983-4659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANLY FAMILY CARE CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSEN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "MERRIMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-983-3121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "24425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890243C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IND.",
            "identifier": "46027",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "0243C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080077493",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albemarle, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.