Individual provider Active NPI

Wesley William Carr, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Fort Liberty, NC
National Provider Identifier
1124432430
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
2016018274 Issued in MO
Practice address
2817 Rock Merritt Ave Womack Army Medical Center
Fort Liberty, NC 28310-0001
Phone
(910) 907-8922
Fax
(910) 907-6069
NPI assigned
Jun 13, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2016018274 MO
Sports Medicine (Family Medicine) Physician 207QS0010X 2016018274 MO Primary

Addresses

Primary practice location

2817 Rock Merritt Ave Womack Army Medical Center
Fort Liberty, NC 28310-0001

Mailing address

2817 Rock Merritt Ave Womack Army Medical Center
Fort Liberty, NC 28310-0001
Phone (910) 907-8922

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151230000971 MO Order and Referring Only - Family PracticePractitioner - Family Practice 4981906419

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

11330 Olive Blvd
Suite 150
Creve Coeur, MO 63141-7149

1402 S Grand Blvd
M260
Saint Louis, MO 63104-1004

1402 S Grand Blvd
M260
Saint Louis, MO 63104-1078

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1402617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1124432430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER",
            "city": "FORT LIBERTY",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-8922",
            "fax_number": "910-907-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER",
            "city": "FORT LIBERTY",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-8922",
            "fax_number": "910-907-6069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARR",
        "first_name": "WESLEY",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-13",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2016018274",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MO",
            "license": "2016018274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Liberty, NC

Sources for this page

Verify at the official NPI Registry.