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MASONBORO FAMILY MEDICINE, P.C.
NPI 1417018565
Preferred Provider Organization in Wilmington, NC

Active since December 13, 2006CLIA 34D1017476 · Microscopy
6419 CAROLINA BEACH ROAD, SUITE A, WILMINGTON, NC 28412(910) 790-3660 Get Directions Write a Review

NPPES record last updated: January 3, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Masonboro Family Medicine, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MASONBORO FAMILY MEDICINE, P.C. (NPI 1417018565) is a healthcare organization registered as a preferred provider organization in Wilmington, North Carolina and active in the NPI registry since December 2006. The organization holds a CLIA Microscopy certificate valid through September 25, 2027 and lists Erin Carter, Billing Office, as its authorized official.

NPPES Registry Identity

NPI1417018565
Entity TypeOrganization
Primary Taxonomy305R00000X
Legal Business NameMASONBORO FAMILY MEDICINE, P.C.
Location Address6419 CAROLINA BEACH ROAD, SUITE AWilmington, NC 28412-2788
Mailing Address6419 Carolina Beach Road, Suite AWilmington, NC 28412-2788 · (910) 790-3660
Phone(910) 790-3660
Organization SubpartNo
Authorized OfficialErin CarterBilling Office · (910) 790-3660
Enumeration DateDecember 13, 2006
Last NPPES UpdateJanuary 3, 2011
✔ NPI 1417018565 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPreferred Provider OrganizationManaged Care Organizations
Taxonomy Code305R00000X
Definition
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.
6419 CAROLINA BEACH ROAD, Wilmington, NC 28412
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Other Identifiers 19

Medicare UPINF36078NC
Medicare UPINE21368
Medicaid015C3NC
Medicare PIN2192374B
Medicare PIN1022110001NC
Other87545NC · Bcbs
Other18265NC · Bcbs
Medicare UPING06165NC
Medicaid8910892NC
Medicare UPINS62999NC
Other051C3NC · Bcbs
Medicare PIN201605BNC
Medicare UPINS83378NC
Medicare PIN2335346
Other10892NC · Bcbs Nc
Medicare NSC1022110001NC
Medicaid8961634NC
Other61634NC · Bcbs
Medicare UPINC85249

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 for Provider-Performed Microscopy Procedures (PPMP) 34D1017476

Masonboro Family Medicine PC · Wilmington, NC
Active · expires Sep 25, 2027
CLIA Number34D1017476
Laboratory TypePractitioner Other
Certificate Effective DateSeptember 26, 2025
Certificate Expiration DateSeptember 25, 2027
Laboratory DirectorAndrew N. Illobre Pa-C
Laboratory Phone(910) 790-3660
Laboratory LocationMasonboro Family Medicine PC6419-A Carolina Beach Rd, Wilmington, NC 28412
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. KIMBERLY J MARTIN PA-C
Physician Assistant (Medical)
6419 CAROLINA BEACH ROAD, SUITE A
WILMINGTON, NC 28412
New Hanover County (910) 790-3660

Frequently 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 Masonboro Family Medicine, P.C.'s NPI number?

The NPI number for Masonboro Family Medicine, P.C. is 1417018565. It was assigned to this organization in the NPPES registry on December 13, 2006.

Where is Masonboro Family Medicine, P.C. located?

Masonboro Family Medicine, P.C. is located at 6419 Carolina Beach Road Suite A, Wilmington, NC 28412. The listed phone number is (910) 790-3660.

What is Masonboro Family Medicine, P.C.'s specialty?

The primary specialty registered for this NPI is Preferred Provider Organization with taxonomy code 305R00000X.

Does Masonboro Family Medicine, P.C. hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 34D1017476) is associated with this NPI, valid through September 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Masonboro Family Medicine, P.C. was last updated on January 3, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years 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.