Active NPI
Mark B Wise, PT
- Physical Therapist
- Beaufort, NC
National Provider Identifier
1962468637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10600
- Practice address
- 106A Professional Park Dr
Beaufort, NC 28516-2418 - Phone
- (252) 838-0222
- Fax
- (252) 838-0224
- NPI assigned
- Apr 21, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT08833 | OH | |
| Physical Therapist | 225100000X | 10600 | NC | Primary |
Addresses
Primary practice location
106A Professional Park Dr
Beaufort, NC 28516-2418
Mailing address
106A Professional Park Dr
Beaufort, NC 28516-2418
Phone (252) 838-0222
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 341490517027 | Other | OH | CARESOURCE |
| 654140 | Other | OH | AETNA |
| 2167462 | Medicaid | OH | |
| 000000329159 | Other | OH | ANTHEM BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT08833 | OH | MD | Physical Therapist |
| 10600 | NC | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beaufort Physical Therapy Limited Partnership | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapy Clinic/Center
- Beaufort, NC
- NPI 1598780744
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962468637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106A PROFESSIONAL PARK DR",
"city": "BEAUFORT",
"state": "NC",
"postal_code": "285162418",
"telephone_number": "252-838-0222",
"fax_number": "252-838-0224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106A PROFESSIONAL PARK DR",
"city": "BEAUFORT",
"state": "NC",
"postal_code": "285162418",
"telephone_number": "252-838-0222",
"fax_number": "252-838-0224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "MARK",
"middle_name": "B",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "PT08833",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "10600",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE",
"identifier": "341490517027",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "654140",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2167462",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "000000329159",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaufort, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.