Organization Active NPI

Wilmington Medical Group PA

Doing business as Whiteville Family Practice & Urgent Care PA

  • Family Medicine Physician
  • Whiteville, NC
National Provider Identifier
1104962612
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WILMINGTON MEDICAL GROUP PA
Doing business as
Whiteville Family Practice & Urgent Care PA
Practice address
614 N JK Powell Blvd
Whiteville, NC 28472-3008
Phone
(910) 640-2009
Fax
(910) 251-7777
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Authorized official

Name
James Henry Pridgen, M.D.NPI 1215083563
Title
Medical Director
Phone
(910) 640-2009

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

614 N JK Powell Blvd
Whiteville, NC 28472-3008

Mailing address

1925A Oleander Dr
Wilmington, NC 28403-2334
Phone (910) 251-8851

Other identifiers 3

IdentifierTypeStateIssuer
230038OtherNCMEDICARE
89012TPMedicaidNC
012TPOtherNCBCBS

Other names 1

  • Whiteville Family Practice & Urgent Care PA Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1104962612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925A OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284032334",
            "telephone_number": "910-251-8851",
            "fax_number": "910-251-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 N JK POWELL BLVD",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284723008",
            "telephone_number": "910-640-2009",
            "fax_number": "910-251-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "PRIDGEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "910-640-2009",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "230038",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89012TP",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "012TP",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Whiteville Family Practice & Urgent Care PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Whiteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.