Individual provider Active NPI

Dusty Star Graham, FNP

  • Family Nurse Practitioner
  • Pinehurst, NC
National Provider Identifier
1083177679
Registry record updated Dec 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5011698 Issued in NC
Practice address
205 Page Rd
Pinehurst, NC 28374-8798
Phone
(910) 295-5511
NPI assigned
Apr 10, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 210121 NC
Family Nurse Practitioner 363LF0000X 5011698 NC Primary

Addresses

Primary practice location

205 Page Rd
Pinehurst, NC 28374-8798

Mailing address

1303 Carthage St
Sanford, NC 27330-8984
Phone (919) 292-2468

Other practice location 1

1303 Carthage St
Sanford, NC 27330-8984
Phone (919) 292-2468

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mdavey@pinehurstmedical.com

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
I20190829004415 NC Practitioner - Nurse Practitioner 4688902547 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinehurst Medical Clinic IncGroup PAC ID 5991617169, 162 clinicians

Practice addresses (Care Compare)

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
210121NCMDPhysical Medicine & Rehabilitation Physician
5011698NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pinehurst Medical Clinic, Inc. CurrentSince Nov 7, 2022 Accepting new patients
Pinehurst Medical Clinic, Inc. CurrentSince Nov 7, 2022 Accepting new patients
Pinehurst Medical Clinic, Inc. Past Accepting new patients

Locations

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

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

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

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

Interoperability endpoints

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

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672099200000",
    "number": "1083177679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 CARTHAGE ST",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273308984",
            "telephone_number": "919-292-2468",
            "fax_number": "919-292-2167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 PAGE RD",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748798",
            "telephone_number": "910-295-5511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1303 Carthage St",
            "address_purpose": "LOCATION",
            "city": "Sanford",
            "state": "NC",
            "postal_code": "273308984",
            "country_code": "US",
            "telephone_number": "919-292-2468",
            "fax_number": "919-292-2167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "DUSTY",
        "middle_name": "STAR",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-10",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NC",
            "license": "210121",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5011698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdavey@pinehurstmedical.com",
            "affiliation": "N",
            "address_1": "205 Page Rd",
            "city": "Pinehurst",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283748798",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pinehurst, NC

Sources for this page

Verify at the official NPI Registry.