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SHALOM MEDICAL PC
NPI 1467759985
Clinic/Center - Primary Care in Jacksonville, NC

Active since February 18, 2011
1102 HENDERSON DR, JACKSONVILLE, NC 28540(731) 334-9011(731) 288-1628 Get Directions Write a Review

NPPES record last updated: February 18, 2011. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Shalom Medical Pc NPPES

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

SHALOM MEDICAL PC (NPI 1467759985) is a healthcare organization registered as a primary care in Jacksonville, North Carolina and active in the NPI registry since February 2011. The organization lists Benjamin Chukwunonso Mozie, Medical Director/president, as its authorized official.

NPPES Registry Identity

NPI1467759985
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameSHALOM MEDICAL PC
Location Address1102 HENDERSON DRJacksonville, NC 28540-5203
Mailing Address1102 Henderson DrJacksonville, NC 28540-5203 · (731) 334-9011 · Fax (731) 288-1628
Phone(731) 334-9011
Fax(731) 288-1628
Organization SubpartNo
Authorized OfficialBenjamin Chukwunonso MozieMedical Director/president · (731) 334-9011
Enumeration DateFebruary 18, 2011
✔ NPI 1467759985 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in NC · 2010-01876
1102 HENDERSON DR, Jacksonville, NC 28540
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AmeriHealth Caritas Next, Blue Cross and Blue Shield of NC.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)

Shalom Medical Pc 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 Shalom Medical PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Benjamin Mozie, MD
Internal Medicine
NPI 1639195019
1102 HENDERSON DR
Jacksonville, NC 28540
(910) 333-9712
✔ PECOS✔ Accepts MedicareSame address

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 34D2022307

Shalom Medical PC · Jacksonville, NC
Expired · Oct 15, 2026
CLIA Number34D2022307
Laboratory TypePhysician Office
Certificate Effective DateOctober 16, 2024
Certificate Expiration DateOctober 15, 2026
Laboratory DirectorBenjamin C. Mozie
Laboratory Phone(910) 333-9712
Laboratory LocationShalom Medical PC29 Office Park Drive, Jacksonville, NC 28546
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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 Shalom Medical PC's NPI number?

The NPI number for Shalom Medical PC is 1467759985. It was assigned to this organization in the NPPES registry on February 18, 2011.

Where is Shalom Medical PC located?

Shalom Medical PC is located at 1102 Henderson Dr, Jacksonville, NC 28540. The listed phone number is (731) 334-9011.

What is Shalom Medical PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Is Shalom Medical PC enrolled in Medicare?

Yes. Shalom Medical PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Shalom Medical PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Shalom Medical PC. 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.

What insurance does Shalom Medical PC accept?

Health plans from AmeriHealth Caritas Next and Blue Cross and Blue Shield of NC list Shalom Medical PC 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 Shalom Medical PC was last updated on February 18, 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.