NPIMap

Individual provider Active NPI

David J. Huddleston, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Fayetteville, NC
National Provider Identifier
1033170998
Registry record updated Aug 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
2019-0237 Issued in NC
Practice address
1638 Owen Dr
Fayetteville, NC 28304
Phone
(615) 221-4400
NPI assigned
Mar 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 036092804 IL
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 2019-0237 NC Primary

Addresses

Primary practice location

1638 Owen Dr
Fayetteville, NC 28304

Mailing address

5301 Virginia Way Ste 300
Brentwood, TN 37027-7542
Phone (615) 221-4400

Other practice location 1

1800 E Lake Shore Dr
Decatur, IL 62521-3883
Phone (217) 464-2966

Other identifiers 2

IdentifierTypeStateIssuer
0360928042MedicaidIL
220026797OtherILRR MCR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, NC, GA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20101105001139 IL Practitioner - Pathology 0941495766 Reassigns benefits to 1 organization
I20190916002345 NC Practitioner - Pathology 0941495766 Reassigns benefits to 1 organization
I20220831000995 GA Practitioner - Pathology 0941495766 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Southern Illinois University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Pathologists, LLCGroup PAC ID 0648167544, 137 clinicians

Practice addresses (Care Compare)

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (615) 221-4400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Pathologists, LLC Anatomic Pathology & Clinical Pathology CurrentSince Jul 6, 2019 Accepting new patients
K M B S C Anatomic Pathology & Clinical Pathology Current Accepting new patients
Physician Services Corporation of Southern Illinois Inc. CurrentSince Nov 16, 2015 Accepting new patients
Associated Pathologists LLC Past Accepting new patients

Locations

777 Hemlock St
Macon, GA 31201
Phone (478) 474-5600

811 Fairfax St
Carlyle, IL 62231
Phone (618) 594-3025

422 W White St
Clinton, IL 61727
Phone (217) 935-9570

1800 E Lake Shore Dr
Decatur, IL 62521
Phone (217) 464-2729

2 Good Samaritan Way
Ste 405
Mount Vernon, IL 62864
Phone (618) 899-4000

2 Good Samaritan Way
Ste 320
Mount Vernon, IL 62864
Phone (618) 899-1944

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

5301 Virginia Way
Ste 300
Brentwood, TN 37027
Phone (615) 695-4977

1010 Airpark Center Dr
Nashville, TN 37217
Phone (615) 221-4447

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564963200000",
    "number": "1033170998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 VIRGINIA WAY STE 300",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277542",
            "telephone_number": "615-221-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1638 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28304",
            "telephone_number": "615-221-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 E Lake Shore Dr",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625213883",
            "country_code": "US",
            "telephone_number": "217-464-2966",
            "fax_number": "217-464-3193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUDDLESTON",
        "first_name": "DAVID",
        "middle_name": "J.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-30",
        "last_updated": "2019-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "036092804",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NC",
            "license": "2019-0237",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360928042",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "220026797",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.