OPEN WATER MEDICAL, PA
NPI 1720550940
Clinic/Center in Goldsboro, NC
NPI Status: Active since December 28, 2018
Contact Information
1209 E ASH ST
GOLDSBORO, NC
ZIP 27530
Phone: (919) 734-9455
Fax: (919) 734-4769
- Organization
- Clinic/Center
- CLIA Number: 34D0239917
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-31-2026
About OPEN WATER MEDICAL, PA
This page provides the complete NPI Profile along with additional information for Open Water Medical, Pa, a provider established in Goldsboro, North Carolina operating as a Clinic/center. The healthcare provider is registered in the NPI registry with number 1720550940 assigned on December 2018. The practitioner's primary taxonomy code is 261Q00000X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Tisha Rae Smith (Practice Manager)
- NPI
- 1720550940
- Provider Name
- OPEN WATER MEDICAL, PA
- Entity Type
- Organization
- Location Address
- 1209 E ASH ST GOLDSBORO, NC 27530
- Location Phone
- (919) 734-9455
- Location Fax
- (919) 734-4769
- Mailing Address
- 1620C LIVE OAK ST BEAUFORT, NC 28516
- Mailing Phone
- (252) 728-5737
- Mailing Fax
- (919) 734-4769
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 12-28-2018
- Last Update Date
- 02-24-2022
- 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
Clinic/Center
- Taxonomy Code
- 261Q00000X
- Type
- Ambulatory Health Care Facilities
- Taxonomy Description
- A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Group Taxonomy 193400000X MULTIPLE SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
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
- 34D0239917
- Facility Type
- Physician Office
- Certificate Effective Date
- September 01, 2024
- Certificate Expiration Date
- August 31, 2026
- Laboratory Director
- KERRY A. WILLIS
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Open Water Medical, Pa 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 1720550940, we treat the final digit (0) 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 60. The final step is to find the difference between that total and the next multiple of ten (60 - 60 = 0).
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 60 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
GOLDSBORO, NC 27530
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1720550940, enumerated as an "organization" on December 28, 2018.
The provider is located at 1209 E ASH ST GOLDSBORO, NC 27530 and the phone number is (919) 734-9455.
Clinic/Center with taxonomy code 261Q00000X.
