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OPEN WATER MEDICAL, PA
NPI 1497490957
Family Medicine in Jacksonville, NC

Active since April 29, 2022CLIA Certified · 3 labs
11 OFFICE PARK DR, JACKSONVILLE, NC 28546(910) 353-9906(910) 353-4853 Get Directions Write a Review

NPPES record last updated: April 29, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Open Water Medical, Pa NPPES

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

OPEN WATER MEDICAL, PA (NPI 1497490957) is a healthcare organization registered as a family medicine in Jacksonville, North Carolina and active in the NPI registry since April 2022. The organization holds 3 active CLIA laboratory certificates and lists Tisha Rae Smith, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1497490957
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameOPEN WATER MEDICAL, PA
Location Address11 OFFICE PARK DRJacksonville, NC 28546-7326
Mailing Address1620c Live Oak StBeaufort, NC 28516-1583 · (252) 728-5737 · Fax (252) 728-5739
Phone(910) 353-9906
Fax(910) 353-4853
Organization SubpartNo
Authorized OfficialTisha Rae SmithPractice Manager · (252) 728-5737
Enumeration DateApril 29, 2022
NPPES CertifiedApril 29, 2022
✔ NPI 1497490957 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
11 OFFICE PARK DR, Jacksonville, NC 28546
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Other Identifiers 1

Medicaid1750482493NC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

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 34D2266985

Open Water Medical, PA · Jacksonville, NC
Active · expires Aug 17, 2026
CLIA Number34D2266985
Laboratory TypePhysician Office
Certificate Effective DateAugust 18, 2024
Certificate Expiration DateAugust 17, 2026
Laboratory DirectorKerry A. Willis
Laboratory Phone(910) 353-9906
Laboratory LocationOpen Water Medical, PA11 Office Park Drive, Jacksonville, NC 28546
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 34D0715294

Open Water Medical, PA · Beaufort, NC
Active · expires May 22, 2028
CLIA Number34D0715294
Laboratory TypePhysician Office
Certificate Effective DateMay 23, 2026
Certificate Expiration DateMay 22, 2028
Laboratory DirectorKerry A. Willis
Laboratory Phone(252) 728-5737
Laboratory LocationOpen Water Medical, PA1620 C Live Oak Street, Beaufort, NC 28516
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.

Certificate of Waiver 34D2254449

Open Water Medical, PA · Newport, NC
Active · expires Mar 2, 2028
CLIA Number34D2254449
Laboratory TypePhysician Office
Certificate Effective DateMarch 3, 2026
Certificate Expiration DateMarch 2, 2028
Laboratory DirectorKerry A. Willis
Laboratory Phone(252) 728-5737
Laboratory LocationOpen Water Medical, PA263 Howard Blvd, Newport, NC 28570
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

GERRIANN BURTON NP
Nurse Practitioner (Family)
11 OFFICE PARK DR
JACKSONVILLE, NC 28546
Onslow County (910) 353-9906
ROBERT ALLEN KRAUSE MD
Family Medicine
11 OFFICE PARK DR
JACKSONVILLE, NC 28546
Onslow County (910) 353-9906
ROBERT A KRAUSE MD, PLLC
Family Medicine
11 OFFICE PARK DR
JACKSONVILLE, NC 28546
Onslow County (910) 353-9906

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 Open Water Medical, PA's NPI number?

The NPI number for Open Water Medical, PA is 1497490957. It was assigned to this organization in the NPPES registry on April 29, 2022.

Where is Open Water Medical, PA located?

Open Water Medical, PA is located at 11 Office Park Dr, Jacksonville, NC 28546. The listed phone number is (910) 353-9906.

What is Open Water Medical, PA's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Open Water Medical, PA hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Open Water Medical, PA was last updated on April 29, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.