NPIMap

Organization Active NPI

Halifax Regional Medical Center Inc

  • Emergency Medical Services (Emergency Medicine) Physician
  • Roanoke Rapids, NC
National Provider Identifier
1992846570
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
H0230 Issued in NC
Legal business name
HALIFAX REGIONAL MEDICAL CENTER INC
Practice address
250 Smith Church Rd
Roanoke Rapids, NC 27870-4914
Phone
(252) 535-8005
Fax
(252) 535-8466
NPI assigned
Feb 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Authorized official

Name
Mrs. Sherry Emery Jensen
Title
Chief Financial Officer
Phone
(252) 535-8005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207PE0004X H0230 NC Primary

Addresses

Primary practice location

250 Smith Church Rd
Roanoke Rapids, NC 27870-4914

Mailing address

250 Smith Church Rd
P.O. Box 1089
Roanoke Rapids, NC 27870-4914
Phone (252) 535-8005

Other identifiers 10

IdentifierTypeStateIssuer
07637OtherNCBLUE CROSS BS ER PHYS.
58593301OtherMDBCBS OF MARYLAND
007265OtherNYEMPIRE BCBS OF NEW YORK
6907637MedicaidNC
8907669MedicaidNC
00242OtherNCBLUE CROSS BLUE SHIELD NC
3400151MedicaidNC
07669OtherNCBCBS EKG
00380OtherSCBCBS OF SOUTH CAROLINA
216203OtherVAANTHEM BC BS OF VIRGINIA

Other names 1

  • HALIFAX MEMORIAL HOSPITAL Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031125000253 NC Part B Supplier - Clinic/Group Practice 5496664062 Receives reassigned benefits from 31 practitioners
3 other NPIs on this enrollment
Practice locations: Roanoke, NC; Roanoke Rapids, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1992846570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 SMITH CHURCH RD",
            "address_2": "P.O. BOX 1089",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278704914",
            "telephone_number": "252-535-8005",
            "fax_number": "252-535-8466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 SMITH CHURCH RD",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278704914",
            "telephone_number": "252-535-8005",
            "fax_number": "252-535-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALIFAX REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "EMERY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "252-535-8005",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "NC",
            "license": "H0230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BS ER PHYS.",
            "identifier": "07637",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MARYLAND",
            "identifier": "58593301",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BCBS OF NEW YORK",
            "identifier": "007265",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6907637",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8907669",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD NC",
            "identifier": "00242",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3400151",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS EKG",
            "identifier": "07669",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF SOUTH CAROLINA",
            "identifier": "00380",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC BS OF VIRGINIA",
            "identifier": "216203",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HALIFAX MEMORIAL HOSPITAL",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "HALIFAX MEMORIAL HOSPITAL",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Roanoke Rapids, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; 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.