NPIMap

Organization Active NPI

Pender Memorial Hospital Incorporated

Doing business as Novant Health Pender Medical Center

  • Critical Access Hospital
  • Burgaw, NC
National Provider Identifier
1033242987
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
H0115 Issued in NC
Legal business name
PENDER MEMORIAL HOSPITAL INCORPORATED
Doing business as
Novant Health Pender Medical Center
Pender Memorial Hospial Ekg
Practice address
507 E Fremont St
Burgaw, NC 28425-5131
Phone
(910) 259-5451
Fax
(910) 259-7136
NPI assigned
Mar 13, 2007
Last updated
Aug 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Authorized official

Name
Mr. David H. Long
Title
Administrator/Site Executive Office
Phone
(910) 259-5451

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X H0115 NC Primary

Addresses

Primary practice location

507 E Fremont St
Burgaw, NC 28425-5131

Mailing address

507 E Fremont St
Burgaw, NC 28425-5131
Phone (910) 259-5451

Other identifiers 2

IdentifierTypeStateIssuer
8907714MedicaidNC
8969959MedicaidNC

Other names 3

  • Novant Health Pender Medical Center Doing business as
  • PENDER MEMORIAL HOSPIAL EKG Doing business as
  • Pender Memorial Hospital EKG Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040301000887 NC Part B Supplier - Clinic/Group Practice 9638066095 Receives reassigned benefits from 150 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burgaw, NC

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Pender Memorial Hosp Crna7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1033242987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 E FREMONT ST",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "284255131",
            "telephone_number": "910-259-5451",
            "fax_number": "910-259-7136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 E FREMONT ST",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "284255131",
            "telephone_number": "910-259-5451",
            "fax_number": "910-259-7136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENDER MEMORIAL HOSPITAL INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "ADMINISTRATOR/SITE EXECUTIVE OFFICE",
        "authorized_official_telephone_number": "910-259-5451",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NC",
            "license": "H0115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8907714",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8969959",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Pender Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PENDER MEMORIAL HOSPIAL EKG",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pender Memorial Hospital EKG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Burgaw, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.