BEACH PRIMARY CARE AND WELLNESS PLLC
NPI 1053103796
Family Medicine in Supply, NC
About Beach Primary Care And Wellness Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BEACH PRIMARY CARE AND WELLNESS PLLC (NPI 1053103796) is a healthcare organization registered as a family medicine in Supply, North Carolina and active in the NPI registry since May 2025. The organization holds a CLIA Waiver certificate valid through August 17, 2027 and lists Mary Rudd Crichton, Family Nurse Practitioner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Beach Primary Care And Wellness Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Beach Primary Care And Wellness PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 34D2328806
Beach Primary Care And Wellness, PLLC · Supply, NCFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Beach Primary Care And Wellness PLLC's NPI number?
The NPI number for Beach Primary Care And Wellness PLLC is 1053103796. It was assigned to this organization in the NPPES registry on May 19, 2025.
Where is Beach Primary Care And Wellness PLLC located?
Beach Primary Care And Wellness PLLC is located at 863 Ocean Hwy W, Supply, NC 28462. The listed phone number is (910) 995-7022.
What is Beach Primary Care And Wellness PLLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Beach Primary Care And Wellness PLLC enrolled in Medicare?
Yes. Beach Primary Care And Wellness PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Beach Primary Care And Wellness PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Beach Primary Care And Wellness PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Beach Primary Care And Wellness PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 34D2328806) is associated with this NPI, valid through August 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Beach Primary Care And Wellness PLLC accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and Blue Cross and Blue Shield of NC list Beach Primary Care And Wellness PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Beach Primary Care And Wellness PLLC was last updated on March 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Beach Primary Care And Wellness Pllc · NPI 1053103796
Family Medicine organization in Supply, North Carolina. Organization record, active in the CMS NPPES registry since May 19, 2025.
## Identity
- **NPI:** 1053103796 (Entity type: Organization)
- **Enumerated:** May 19, 2025
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Mary Crichton, FAMILY NURSE PRACTITIONER
## Practice location
- **Address:** 863 OCEAN HWY W, Supply, NC 28462-4059
- **Phone:** (910) 995-7022
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 26, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1053103796) · Data from the CMS NPPES public registry.