Basic Information
Provider Information | |||||||||
NPI: | 1164524278 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CUMMINGS | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | LEE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | II | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3100 SPRING FOREST RD | ||||||||
Address2: | SUITE 130 | ||||||||
City: | RALEIGH | ||||||||
State: | NC | ||||||||
PostalCode: | 276162880 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9198739533 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1705 TARBORO ST SW | ||||||||
Address2: |   | ||||||||
City: | WILSON | ||||||||
State: | NC | ||||||||
PostalCode: | 278933428 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2523998040 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/01/2006 | ||||||||
LastUpdateDate: | 04/09/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 9400766 | NC | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 26459 | 01 | NC | BCBS NC | OTHER | 050091678 | 01 | NC | RAILROAD-MEDICARE | OTHER | 8926459 | 05 | NC |   | MEDICAID | C3660 | 01 | NC | MEDCOST | OTHER | 7185175 | 01 | NC | CIGNA | OTHER | 802807 | 01 | NC | PARTNERS | OTHER |