NPIMap

Organization Active NPI

Southeastern Regional Medical Center

Doing business as Johnson Medical Clinic

  • Rural Health Clinic/Center
  • Red Springs, NC
National Provider Identifier
1972595601
Registry record updated Jan 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H0064 Issued in NC
Legal business name
SOUTHEASTERN REGIONAL MEDICAL CENTER
Doing business as
Johnson Medical Clinic
Practice address
222 S Main St
Red Springs, NC 28377-1622
Phone
(910) 843-4576
Fax
(910) 843-2301
NPI assigned
Aug 18, 2005
Last updated
Jan 27, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2009

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

Authorized official

Name
Charles Thomas Johnson III
Title
Cfo
Phone
(910) 671-5090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H0064 NC Primary

Addresses

Primary practice location

222 S Main St
Red Springs, NC 28377-1622

Mailing address

2600 N Elm St
Lumberton, NC 28358-3011
Phone (910) 272-3051

Other identifiers 3

IdentifierTypeStateIssuer
343415AMedicaidNC
0185KOtherNCBLUE CROSS BLUE SHIELD
343415CMedicaidNC

Other names 1

  • Johnson Medical Clinic 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
Tax ID family
Southeastern Regional Medical Center38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233014400000",
    "number": "1972595601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 N ELM ST",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283583011",
            "telephone_number": "910-272-3051",
            "fax_number": "910-738-3764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S MAIN ST",
            "city": "RED SPRINGS",
            "state": "NC",
            "postal_code": "283771622",
            "telephone_number": "910-843-4576",
            "fax_number": "910-843-2301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2009-01-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "910-671-5090",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NC",
            "license": "H0064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "343415A",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0185K",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "343415C",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johnson Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Red Springs, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2009; 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.