CATAWBA VALLEY PRIMARY CARE, PLLC - NPI NUMBER 1720161805

Summary

Provider Name: CATAWBA VALLEY PRIMARY CARE, PLLC

NPI Number: 1720161805

Clasification: Family Medicine (207Q00000X)

Address:
2180 NORTHWEST BLVD
SUITE A
NEWTON, NC
ZIP 28658

Phone Number: (828) 464-7800



Detailed Information

CATAWBA VALLEY PRIMARY CARE, PLLC is a family physician in Newton, NC. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. The assigned NPI number for this provider is 1720161805 and is registered as an organization entity type and is a multi-specialty group.

The provider's business address is:

2180 NORTHWEST BLVD
SUITE A
NEWTON, NC
ZIP 28658-724
Phone: (828) 464-7800
Fax: (828) 464-7825

The provider's authorized official is Raymond H Osterer .
The authorized official title is Owner and has the following contact phone number (828) 464-7800.

The enumeration date for this NPI number is 10/23/2006 and was last updated on 12/10/2009.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207Q00000X Family Medicine Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 011RE OTHER NC BCBS GROUP #
2 2334750 MEDICARE ID-TYPE UNSPECIFIED NC GROUP #
3 89011RE MEDICAID NC
4 R77871 MEDICARE UPIN NC
5 F54531 MEDICARE UPIN

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1720161805 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name CATAWBA VALLEY PRIMARY CARE, PLLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 2180 NORTHWEST BLVD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address SUITE A The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name NEWTON The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name NC The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 286583724 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 8284647800 The telephone number associated with the location address of the provider being identified.
12 Provider Business Practice Location Address Fax Number 8284647825 The fax number associated with the location address of the provider being identified.
13 Provider Enumeration Date 10/23/2006 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 12/10/2009 The date that a record was last updated or changed.
15 Authorized Official Last Name OSTERER The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official First Name RAYMOND The first name of the authorized official.
17 Authorized Official Middle Name H The middle name of the authorized official.
18 Authorized Official Title or Position OWNER The title or position of the authorized official.
19 Authorized Official Telephone Number 8284647800 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 207Q00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 011RE Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
23 Other Provider Identifier Type Code 1 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier State 1 NC
25 Other Provider Identifier Issuer 1 BCBS GROUP #
26 Other Provider Identifier 2 2334750 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier Type Code 2 04 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier State 2 NC
29 Other Provider Identifier Issuer 2 GROUP #
30 Other Provider Identifier 3 89011RE Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier Type Code 3 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
32 Other Provider Identifier State 3 NC
33 Other Provider Identifier 4 R77871 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
34 Other Provider Identifier Type Code 4 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
35 Other Provider Identifier State 4 NC
36 Other Provider Identifier 5 F54531 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
37 Other Provider Identifier Type Code 5 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
38 Is Organization Subpart N
39 Authorized Official Credential Text PHYSICIAN ASSISTANT
40 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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