NPI |
1720361751 |
The city name in the location address of the provider being identified. |
Entity Type Code |
1 |
The State code in the location of the provider
being identified. |
Provider Last Name Legal Name |
EVES |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider First Name |
ERIN |
The country code in the location address of the provider being identified. |
Provider Middle Name |
JOY |
The telephone number associated with the location address of the provider being identified. |
Provider Credential Text |
NP |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider First Line Business Practice Location Address |
5509 CREEDMOOR RD |
The date that a record was last updated or changed. |
Provider Business Practice Location Address City Name |
RALEIGH |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address State Name |
NC |
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. |
Provider Business Practice Location Address Postal Code |
276126312 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
9195736520 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Enumeration Date |
9/26/2011 |
The title or position of the authorized official. |
Last Update Date |
7/11/2014 |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
163W00000X |
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. |
Provider License Number 1 |
232888 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
NC |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
363LP0808X |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider License Number 2 |
5006990 |
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. |
Provider License Number State Code 2 |
NC |
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. |
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |