NPIMap

Organization Active NPI

RPK Center for Rehab, Spine & Pain

  • Physical Medicine & Rehabilitation Physician
  • Fayetteville, NC
National Provider Identifier
1093778110
Registry record updated Dec 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
RPK CENTER FOR REHAB, SPINE & PAIN
Practice address
2109 Valleygate Drive
Suite 201
Fayetteville, NC 28304
Phone
(910) 486-8880
Fax
(910) 486-8886
NPI assigned
Apr 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2011

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

Authorized official

Name
Dr. David Kishbaugh, D.O.NPI 1053374157
Title
Manager-Member/Owner
Phone
(910) 486-8880

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

2109 Valleygate Drive
Suite 201
Fayetteville, NC 28304

Mailing address

2109 Valleygate Drive
Suite 201
Fayetteville, NC 28304
Phone (910) 486-8880

Other identifiers 1

IdentifierTypeStateIssuer
89015WRMedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040507001264 NC Part B Supplier - Clinic/Group Practice 0749279438 Receives reassigned benefits from 12 practitioners
Practice locations: Fayetteville, NC; Southern Pines, NC

National Provider Directory

National Provider Directory

Locations

3551 Dunn Rd
Eastover, NC 28312
Phone (910) 483-6277

2109 Valleygate Dr
Fayetteville, NC 28304

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323302400000",
    "number": "1093778110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 VALLEYGATE DRIVE",
            "address_2": "SUITE 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28304",
            "telephone_number": "910-486-8880",
            "fax_number": "910-486-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 VALLEYGATE DRIVE",
            "address_2": "SUITE 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28304",
            "telephone_number": "910-486-8880",
            "fax_number": "910-486-8886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RPK CENTER FOR REHAB, SPINE & PAIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2011-12-08",
        "status": "A",
        "authorized_official_last_name": "KISHBAUGH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MANAGER-MEMBER/OWNER",
        "authorized_official_telephone_number": "910-486-8880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89015WR",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; 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.