NPIMap

Organization Active NPI

Millennium Physician Group of NC, PLLC

  • Internal Medicine Physician
  • Durham, NC
National Provider Identifier
1073832812
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MILLENNIUM PHYSICIAN GROUP OF NC, PLLC
Practice address
4205 Ben Franklin Blvd
Durham, NC 27704-2143
Phone
(919) 477-6900
Fax
(919) 620-0974
NPI assigned
May 19, 2010
Last updated
Sep 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Authorized official

Name
Mary Haltigan
Title
Director of Revenue Cycle
Phone
(877) 856-3774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

4205 Ben Franklin Blvd
Durham, NC 27704-2143

Mailing address

2675 Winkler Ave Ste 200
Fort Myers, FL 33901-9328
Phone (877) 856-3774

Other practice location 1

5107 Southpark Dr Ste 104
Durham, NC 27713-8400
Phone (919) 477-6900

Other practice location 2

11009 Ingleside Pl Ste 201
Raleigh, NC 27614-6697
Phone (919) 844-4344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100706000763 NC Part B Supplier - Clinic/Group Practice 2567593635 Receives reassigned benefits from 32 practitioners
Practice locations: Durham, NC; Raleigh, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0688159Millennium Physician Group of NC, PLLC4205 Ben Franklin Boulevard, Durham, NC 27704ComplianceSep 13, 2027
34D2045925Millennium Physician Group of NC PLLC11009 Ingleside Place, Suite 201, Raleigh, NC 27614Certificate of waiverOct 26, 2027

National Provider Directory

National Provider Directory

Locations

2675 Winkler Ave
Ste 200
Fort Myers, FL 33901

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2523/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1274227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758499200000",
    "number": "1073832812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE STE 200",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019328",
            "telephone_number": "877-856-3774",
            "fax_number": "395-992-6122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 BEN FRANKLIN BLVD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277042143",
            "telephone_number": "919-477-6900",
            "fax_number": "919-620-0974"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5107 Southpark Dr Ste 104",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277138400",
            "country_code": "US",
            "telephone_number": "919-477-6900",
            "fax_number": "919-620-0974",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11009 Ingleside Pl Ste 201",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276146697",
            "country_code": "US",
            "telephone_number": "919-844-4344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MILLENNIUM PHYSICIAN GROUP OF NC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-19",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A",
        "authorized_official_last_name": "HALTIGAN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "877-856-3774"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.