Organization Active NPI

Med First Immediate Care & Family Practice, PA

  • Family Medicine Physician
  • Jacksonville, NC
National Provider Identifier
1053503763
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9801392 Issued in NC
Legal business name
MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA
Practice address
609 Richlands Hwy Ste 6
Jacksonville, NC 28540-3606
Phone
(910) 455-7888
Fax
(910) 455-1403
NPI assigned
Aug 16, 2007
Last updated
Dec 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

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

Authorized official

Name
Mr. Paul Feneck
Title
Ceo
Phone
(919) 341-4016

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9801392 NC Primary

Addresses

Primary practice location

609 Richlands Hwy Ste 6
Jacksonville, NC 28540-3606

Mailing address

1616 E Millbrook Rd Ste 110
Raleigh, NC 27609-4971
Phone (919) 341-4016

Other identifiers 1

IdentifierTypeStateIssuer
8911515MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080124000674 NC Part B Supplier - Clinic/Group Practice 0446332720 Receives reassigned benefits from 107 practitioners
Practice locations: Jacksonville, NC; Raleigh, NC; Richlands, NC; Roanoke Rapids, NC; Roxboro, NC; Smithfield, NC; Sneads Ferry, NC; Southport, NC…
O20121116000139 SC Part B Supplier - Clinic/Group Practice 0446332720 Receives reassigned benefits from 6 practitioners
Practice locations: Leesville, SC

National Provider Directory

National Provider Directory

Locations

1800 E Franklin St
Ste 11A
Chapel Hill, NC 27514
Phone (919) 968-1985

1515 Sunset Ave
Clinton, NC 28328
Phone (910) 491-9418

2002 S Glenburnie Rd
Ste 100
New Bern, NC 28562
Phone (252) 631-5188

3396 Six Forks Rd
Raleigh, NC 27609
Phone (919) 781-8897

130 Cardinal Dr
Roanoke Rapids, NC 27870
Phone (252) 308-0686

102 Southtown Cir
Rolesville, NC 27571
Phone (919) 554-9412

388 Venture Dr
Ste 1
Smithfield, NC 27577
Phone (919) 209-0796

5130 Southport Supply Rd SE
Unit 1011
Southport, NC 28461
Phone (910) 269-2053

718 W Corbett Ave
Swansboro, NC 28584
Phone (910) 326-5588

3604 Roger Branch Rd
Ste 106
Wake Forest, NC 27587
Phone (919) 570-2000

608 E Columbia Ave
Leesville, SC 29070
Phone (803) 532-0051

Practitioners & affiliated clinicians

Practitioners 118

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 118

NPI Registry JSON

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

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1053503763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 E MILLBROOK RD STE 110",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276094971",
            "telephone_number": "919-341-4016",
            "fax_number": "910-346-1907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 RICHLANDS HWY STE 6",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285403606",
            "telephone_number": "910-455-7888",
            "fax_number": "910-455-1403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-16",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A",
        "authorized_official_last_name": "FENECK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-341-4016",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9801392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8911515",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; 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.