MASONBORO FAMILY MEDICINE, P.C.
NPI 1417018565
Preferred Provider Organization in Wilmington, NC
NPI Status: Active since December 13, 2006
Contact Information
6419 CAROLINA BEACH ROAD
SUITE A
WILMINGTON, NC
ZIP 28412
Phone: (910) 790-3660
- Organization
- Preferred Provider Organization
- CLIA Number: 34D1017476
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 09-25-2027
About MASONBORO FAMILY MEDICINE, P.C.
This page provides the complete NPI Profile along with additional information for Masonboro Family Medicine, P.c., a provider established in Wilmington, North Carolina operating as a Preferred Provider Organization. The healthcare provider is registered in the NPI registry with number 1417018565 assigned on December 2006. The practitioner's primary taxonomy code is 305R00000X. The provider is registered as an organization and their NPI record was last updated 15 years ago. The authorized official of this NPI record is Mrs. Erin Carter (Billing Office)
- NPI
- 1417018565
- Provider Name
- MASONBORO FAMILY MEDICINE, P.C.
- Entity Type
- Organization
- Location Address
- 6419 CAROLINA BEACH ROAD SUITE A WILMINGTON, NC 28412
- Location Phone
- (910) 790-3660
- Mailing Address
- 6419 CAROLINA BEACH ROAD SUITE A WILMINGTON, NC 28412
- Mailing Phone
- (910) 790-3660
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 12-13-2006
- Last Update Date
- 01-03-2011
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Preferred Provider Organization
- Taxonomy Code
- 305R00000X
- Type
- Managed Care Organizations
- Taxonomy Description
- A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| F36078 | MEDICARE UPIN (02) | NC | |
| E21368 | MEDICARE UPIN (02) | ||
| 015C3 | MEDICAID (05) | NC | |
| 2192374B | MEDICARE PIN (08) | ||
| 1022110001 | MEDICARE PIN (08) | NC | |
| 87545 | OTHER (01) | NC | BCBS |
| 18265 | OTHER (01) | NC | BCBS |
| G06165 | MEDICARE UPIN (02) | NC | |
| 8910892 | MEDICAID (05) | NC | |
| S62999 | MEDICARE UPIN (02) | NC | |
| 051C3 | OTHER (01) | NC | BCBS |
| 201605B | MEDICARE PIN (08) | NC | |
| S83378 | MEDICARE UPIN (02) | NC | |
| 2335346 | MEDICARE PIN (08) | ||
| 10892 | OTHER (01) | NC | BCBS NC |
| 1022110001 | MEDICARE NSC (07) | NC | |
| 8961634 | MEDICAID (05) | NC | |
| 61634 | OTHER (01) | NC | BCBS |
| C85249 | MEDICARE UPIN (02) |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 34D1017476
- Facility Type
- Practitioner Other
- Certificate Effective Date
- September 26, 2025
- Certificate Expiration Date
- September 25, 2027
- Laboratory Director
- ANDREW N. ILLOBRE PA-C
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Masonboro Family Medicine, P.c. in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1417018565, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 55 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
WILMINGTON, NC 28412
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1417018565, enumerated as an "organization" on December 13, 2006.
The provider is located at 6419 CAROLINA BEACH ROAD SUITE A WILMINGTON, NC 28412 and the phone number is (910) 790-3660.
Preferred Provider Organization with taxonomy code 305R00000X.
The provider might be accepting Accepts: Medicare, Medicaid and Blue Cross Blue Shield. Please consult your insurance carrier or call the provider to verify.
