NPIMap

Organization Active NPI

Pender Memorial Hospital Incorporated

Doing business as Novant Health Pender Medical Center

  • Critical Access Hospital
  • Burgaw, NC
National Provider Identifier
1053444901
Registry record updated Oct 8, 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
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
Oct 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

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

Authorized official

Name
Ruth Ann Glaser
Title
President & Coo
Phone
(910) 300-4004

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

PO Box 604271
Charlotte, NC 28260-4271
Phone (336) 277-8757

Other identifiers 1

IdentifierTypeStateIssuer
8000199MedicaidNC

Other names 2

  • Novant Health Pender Medical Center Doing business as
  • Pender Memorial Hospital Anesthesia 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
Practice locations: Burgaw, NC

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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.

Locations

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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Novant Health Home CareRocky Point, NC, CCN 347065 Home health agency 5% Or Greater Direct Ownership Interest Oct 1, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Nhrmc Home Care

    dba Novant Health Home Care

    • Home Health Agency
    • Rocky Point, NC
    • NPI 1144548405

    5% Or Greater Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 151

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 151

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": "1728345600000",
    "number": "1053444901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604271",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282604271",
            "telephone_number": "336-277-8757",
            "fax_number": "336-718-8916"
        },
        {
            "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": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "GLASER",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT & COO",
        "authorized_official_telephone_number": "910-300-4004"
    },
    "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": "8000199",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Pender Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pender Memorial Hospital Anesthesia",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Burgaw, NC

Sources for this page

Verify at the official NPI Registry.