Individual provider Active NPI

William Lee Fenstermacher Jr., PA-C

  • Physician Assistant
  • Leland, NC
National Provider Identifier
1043289028
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
104227 Issued in NC
Practice address
9101 Ocean Hwy E
Leland, NC 28451-7867
Phone
(910) 343-5464
NPI assigned
Mar 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 104227 NC Primary

Addresses

Primary practice location

9101 Ocean Hwy E
Leland, NC 28451-7867

Mailing address

1202 Medical Center Dr
Wilmington, NC 28401-7307
Phone (910) 341-1540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070403000255 NC Practitioner - Physician Assistant 4385748292 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1225OKMDMarriage & Family Therapist
104227NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wilmington ASC LLC CurrentSince Nov 21, 2023 Accepting new patients
Wha Medical Clinic PLLC Current Accepting new patients
Wilmington Health PLLC CurrentSince Nov 21, 2023 Accepting new patients
Wrightsboro Family Practice and Urgent Care LLC Past Accepting new patients
Shallotte Medical Center Inc Past Accepting new patients
Shallotte Medical Center Inc Past Accepting new patients
Carolina Comprehensive Health Network, PA Past Accepting new patients
Shoreview Medical Associates, PLLC Past Accepting new patients
Ucb Properties LLC Past Accepting new patients
Chicora Medical Group PA Past Accepting new patients

Locations

1300 Bridge Barrier Rd
Ste 2
Carolina Beach, NC 28428
Phone (910) 458-4101

9101 Ocean Hwy E
Leland, NC 28451
Phone (910) 343-5464

1333 S Dickinson Dr
Leland, NC 28451
Phone (910) 332-0241

8108 Market St
#B
Wilmington, NC 28411
Phone (910) 686-2099

1202 Medical Center Dr
Wilmington, NC 28401
Phone (910) 617-6705

8108B Market St
Wilmington, NC 28411
Phone (910) 686-2099

Organizations & group practices 10

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1043289028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017307",
            "telephone_number": "910-341-1540",
            "fax_number": "910-431-4048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9101 OCEAN HWY E",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "284517867",
            "telephone_number": "910-343-5464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENSTERMACHER",
        "first_name": "WILLIAM",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "104227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leland, NC

Sources for this page

Verify at the official NPI Registry.