NPIMap

Individual provider Active NPI

Kristos Nektarios Vaughan, D.O.

  • Family Medicine Physician
  • Southport, NC
National Provider Identifier
1134449291
Registry record updated Nov 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2013-00927 Issued in NC
Practice address
3009 Medical Plaza Lane
Southport, NC 28461
Phone
(910) 454-1234
Fax
(910) 253-4934
NPI assigned
Jun 10, 2010
Last updated
Nov 2, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2016

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 2013-00927 NC Primary

Addresses

Primary practice location

3009 Medical Plaza Lane
Southport, NC 28461

Mailing address

3009 Medical Plaza Lane
Southport, NC 28461
Phone (910) 454-1234

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
I20131125000973 NC Practitioner - Family Practice 9032345939 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3009 Medical Plaza LN
Southport, NC 28461-5194
Phone (910) 457-3827

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2013-00927NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
J. Arthur Dosher Memorial Hospital CurrentSince Feb 2, 2015 Accepting new patients
J. Arthur Dosher Memorial Hospital CurrentSince Feb 2, 2015 Accepting new patients
J Arthur Dosher Memorial Hospital Family Medicine Past Accepting new patients

Locations

3009 Medical Plaza Ln
Southport, NC 28461
Phone (910) 454-1234

4222 Long Beach Rd SE
Southport, NC 28461
Phone (910) 269-2053

821 N Atlantic Ave
Southport, NC 28461
Phone (910) 457-3827

823 N Atlantic Ave
Southport, NC 28461
Phone (910) 457-3827

924 N Howe St
Southport, NC 28461
Phone (910) 457-3800

Interoperability endpoints

  • Direct secure messaging: kristos.vaughan@dosher.eclinicaldirectplus.com

Organizations & group practices 4

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 10

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": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478044800000",
    "number": "1134449291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3009 MEDICAL PLAZA LANE",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "28461",
            "telephone_number": "910-454-1234",
            "fax_number": "910-253-4934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3009 MEDICAL PLAZA LANE",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "28461",
            "telephone_number": "910-454-1234",
            "fax_number": "910-253-4934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "KRISTOS",
        "middle_name": "NEKTARIOS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-10",
        "last_updated": "2016-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2013-00927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southport, NC

Sources for this page

Verify at the official NPI Registry.