Individual provider Active NPI

Gretchen Blair Journigan, PA-C

  • Surgical Physician Assistant
  • Greenville, NC
National Provider Identifier
1043215411
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
103051 Issued in NC
Practice address
2245 Stantonsburg Rd
Suite H
Greenville, NC 27834-2868
Phone
(252) 413-0036
Fax
(252) 413-0038
NPI assigned
Jun 14, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 103051 NC Primary

Addresses

Primary practice location

2245 Stantonsburg Rd
Suite H
Greenville, NC 27834-2868

Mailing address

2245 Stantonsburg Rd
Suite H
Greenville, NC 27834-2868
Phone (252) 413-0036

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
103051NCMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Breast & Oncologic Surgery PLLC PastSince Aug 1, 2005 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043215411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2245 STANTONSBURG RD",
            "address_2": "SUITE H",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342868",
            "telephone_number": "252-413-0036",
            "fax_number": "252-413-0038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2245 STANTONSBURG RD",
            "address_2": "SUITE H",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342868",
            "telephone_number": "252-413-0036",
            "fax_number": "252-413-0038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOURNIGAN",
        "first_name": "GRETCHEN",
        "middle_name": "BLAIR",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "103051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.