NPIMap

Individual provider Active NPI

Robert Howard McConville Jr., MD

  • Family Medicine Physician
  • Sanford, NC
National Provider Identifier
1104820133
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20316 Issued in NC
Practice address
1125 Carthage St
Sanford, NC 27330-4162
Phone
(919) 774-6023
Fax
(919) 776-6359
NPI assigned
Jun 8, 2005
Last updated
Jun 23, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20316 NC Primary

Addresses

Primary practice location

1125 Carthage St
Sanford, NC 27330-4162

Mailing address

1125 Carthage St
Sanford, NC 27330-4162
Phone (919) 774-6023

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050824000063 NC Practitioner - Family Practice 5294639126 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

101 Church St
Broadway, NC 27505-9394
Phone (919) 258-6521

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
20316NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Central Carolina Medical Group LLC Current Accepting new patients
DLP Central Carolina Medical Group LLC Family Medicine CurrentSince May 1, 2017 Accepting new patients
DLP Central Carolina Medical Group LLC CurrentSince May 1, 2017 Accepting new patients

Locations

101 Church St
Broadway, NC 27505
Phone (919) 258-6521

75 Old Graham Rd
Pittsboro, NC 27312
Phone (919) 542-2731

1125 Carthage St
Sanford, NC 27330
Phone (919) 774-6023

4546 NC 87 S
Sanford, NC 27332
Phone (919) 499-5151

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15593/brand/16/csg/1/fhir/r4
  • Direct secure messaging: robert.mcconville.1@15593.direct.athenahealth.com
  • Direct secure messaging: robert.mcconville.1@23663.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1104820133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 CARTHAGE ST",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273304162",
            "telephone_number": "919-774-6023",
            "fax_number": "919-776-6359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 CARTHAGE ST",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273304162",
            "telephone_number": "919-774-6023",
            "fax_number": "919-776-6359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCONVILLE",
        "first_name": "ROBERT",
        "middle_name": "HOWARD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-08",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "20316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sanford, NC

Sources for this page

Verify at the official NPI Registry.