TRIAD BEHAVIORAL RESOURCES PC
NPI 1336292556
Family Medicine in Wilmington, NC
NPI Status: Active since January 19, 2007
Contact Information
12 N 5TH AVE
WILMINGTON, NC
ZIP 28401
Phone: (910) 765-1003
Fax: (910) 765-1004
- Organization
- Family Medicine
- Accepts Insurance
- CLIA Number: 34D2182701
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-14-2025
About TRIAD BEHAVIORAL RESOURCES PC
This page provides the complete NPI Profile along with additional information for Triad Behavioral Resources Pc, a primary care provider established in Wilmington, North Carolina operating as a Family Medicine. The healthcare provider is registered in the NPI registry with number 1336292556 assigned on January 2007. The practitioner's primary taxonomy code is 207Q00000X. The provider is registered as an organization and their NPI record was last updated 2 years ago. Triad Behavioral Resources Pc operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The authorized official of this NPI record is David Bolton (Ceo)
- NPI
- 1336292556
- Provider Name
- TRIAD BEHAVIORAL RESOURCES PC
- Entity Type
- Organization
- Location Address
- 12 N 5TH AVE WILMINGTON, NC 28401
- Location Phone
- (910) 765-1003
- Location Fax
- (910) 765-1004
- Mailing Address
- 12 N 5TH AVE WILMINGTON, NC 28401
- Mailing Phone
- (910) 765-1003
- Mailing Fax
- (910) 765-1004
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-19-2007
- Last Update Date
- 09-28-2023
- Code Navigator
A primary care provider (PCP) like Triad Behavioral Resources Pc sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
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
Family Medicine
- Taxonomy Code
- 207Q00000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- 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.
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 | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | MHL041686 (NC) |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Bronze 2 Advanced HSA: Aetna network + MinuteClinic + Virtual Primary Care - HMO
- Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Gold 3 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Silver 5 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Adult Dental+Vision - HMO
- Blue Advantage Bronze Basic | 3 Free PCP | $20 Tier 1 Rx | Integrated | Nationwide Doctors - PPO
- Blue Advantage Bronze Complete | $60 PCP | $20 Tier 1 Rx | Nationwide Doctors - PPO
- Blue Advantage Bronze Standard | Nationwide Doctors - PPO
- Blue Advantage Gold Premier | 3 Free PCP | $10 Tier 1 Rx | Nationwide Doctors - PPO
- Blue Advantage Gold Standard | Nationwide Doctors - PPO
- Blue Advantage Silver Choice | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors - PPO
- Blue Advantage Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | Nationwide Doctors - PPO
- Blue Advantage Silver Standard | Nationwide Doctors - PPO
- Blue Care Bronze Standard | Statewide Doctors - HMO
- Blue Care Gold Standard | Statewide Doctors - HMO
- Blue Care Silver Standard | Statewide Doctors - HMO
- Blue Value Bronze Basic | 3 Free PCP | $20 Tier 1 Rx | Integrated | Limited Statewide Doctors - POS
- Blue Value Bronze Complete | $60 PCP | $20 Tier 1 Rx | Limited Statewide Doctors - POS
- Blue Value Bronze Standard | Limited Statewide Doctors - POS
- Blue Value Gold Premier | 3 Free PCP | $10 Tier 1 Rx | Limited Statewide Doctors - POS
- Blue Value Gold Standard | Limited Statewide Doctors - POS
- Blue Value Silver Choice | 3 Free PCP | $15 Tier 1 Rx | Limited Statewide Doctors - POS
- Blue Value Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | Limited Statewide Doctors - POS
- Blue Value Silver Standard | Limited Statewide Doctors - POS
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 6005083 | MEDICAID (05) | NC | |
| 017U3 | OTHER (01) | NC | BLUE CROSS BLUE SHIELD |
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
- 34D2182701
- Facility Type
- Physician Office
- Certificate Effective Date
- December 15, 2023
- Certificate Expiration Date
- December 14, 2025
- Laboratory Director
- KEIVAN A. ETTEFAGH
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Triad Behavioral Resources Pc after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 3 | 3 | 6 | 2 | 9 | 2 | 5 | 5 | 6 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 3 | 6 | 6 | 4 | 9 | 4 | 5 | 10 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 3 + 6 + 6 + 4 + 9 + 4 + 5 + 1 + 0 + 24 = 64 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 64 = 6 | 6 | ||||||||
The NPI number 1336292556 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 2 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1427101617 | DAVID BOLTON M.ED., LPC Individual | Counselor (Mental Health) | 12 N 5TH AVE WILMINGTON, NC 28401 (910) 765-1003 |
| 1770319691 | DR. TAMEKI LAVETTE MONGO FNP Individual | Nurse Practitioner (Family) | 12 N 5TH AVE WILMINGTON, NC 28401 (910) 765-1003 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1336292556, enumerated in the NPI registry as an "organization" on January 19, 2007
The provider is located at 12 N 5th Ave Wilmington, Nc 28401 and the phone number is (910) 765-1003
This medical organization specializes in Family Medicine with taxonomy code 207Q00000X
The provider might be accepting Accepts: Aetna CVS Health, Blue Cross and Blue Shield of. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 34D2182701 for a "physician office" facility with a CLIA Certificate of Compliance. This CLIA certificate is issued after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing..
This NPI record was last updated on January 19, 2007. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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