NPIMap

Individual provider Active NPI

Victoria L Cooper, FNP

  • Family Nurse Practitioner
  • Southern Pines, NC
National Provider Identifier
1063120152
Registry record updated Jan 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5020102 Issued in NC
Practice address
200 Pavilion Way
Southern Pines, NC 28387-4561
Phone
(910) 246-4140
Fax
(865) 381-1509
NPI assigned
Nov 8, 2022
Last updated
Jan 28, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5020102 NC Primary

Addresses

Primary practice location

200 Pavilion Way
Southern Pines, NC 28387-4561

Mailing address

200 Pavilion Way
Southern Pines, NC 28387-4561
Phone (910) 246-4140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221229001504 TN Practitioner - Nurse Practitioner 5496125809 Reassigns benefits to 1 organization
I20240802000039 NC Practitioner - Nurse Practitioner 5496125809 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians
Pinehurst Medical Clinic IncGroup PAC ID 5991617169, 162 clinicians

Practice addresses (Care Compare)

101 Brucewood Rd
Southern Pines, NC 28387-5159
Phone (910) 970-4713

200 Pavilion Way
Southern Pines, NC 28387-4561
Phone (910) 295-5511

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5020102NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pinehurst Medical Clinic, Inc. CurrentSince Aug 5, 2024 Accepting new patients
Pinehurst Medical Clinic, Inc. CurrentSince Aug 5, 2024 Accepting new patients
Summit Medical Group, PLLC CurrentSince Nov 6, 2022 Accepting new patients
Summit Medical Group, PLLC CurrentSince Nov 6, 2022 Accepting new patients
Summit Medical Group PLLC PastSince Mar 24, 2024 Accepting new patients
Pinehurst Medical Clinic Inc Past Accepting new patients
Pinehurst Medical Clinic, Inc. Past Accepting new patients

Locations

15 Regional Dr
Pinehurst, NC 28374
Phone (910) 255-4400

205 Page Rd
Pinehurst, NC 28374
Phone (910) 295-9211

200 Pavilion Way
Southern Pines, NC 28387
Phone (910) 235-3330

4208 Murdocksville Rd
West End, NC 27376
Phone (910) 235-5900

1225 E Weisgarber Rd
Ste 200
Knoxville, TN 37909
Phone (865) 938-3627

1275 Dick Lonas Rd
Unit 101
Knoxville, TN 37909

801 Oak Ridge Tpke
Oak Ridge, TN 37830
Phone (865) 482-4088

Interoperability endpoints

  • Direct secure messaging: victoriacooper@phmc.allscriptsdirect.net

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738022400000",
    "number": "1063120152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PAVILION WAY",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283874561",
            "telephone_number": "910-246-4140",
            "fax_number": "865-381-1509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PAVILION WAY",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283874561",
            "telephone_number": "910-246-4140",
            "fax_number": "865-381-1509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "VICTORIA",
        "middle_name": "L",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-08",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5020102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southern Pines, NC

Sources for this page

Verify at the official NPI Registry.