NPIMap

Individual provider Active NPI

Desek Coray Gibson, PA-C

  • Physician Assistant
  • Pinehurst, NC
National Provider Identifier
1144687609
Registry record updated Dec 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-06177 Issued in NC
Practice address
5 Firstvillage Drive
Pinehurst, NC 28374
Phone
(910) 295-6831
Fax
(910) 215-2539
NPI assigned
Jan 28, 2016
Last updated
Dec 5, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-06177 NC Primary

Addresses

Primary practice location

5 Firstvillage Drive
Pinehurst, NC 28374

Mailing address

5 Firstvillage Drive
PO Box 2000
Pinehurst, NC 28374
Phone (910) 295-6831

Other names 1

  • Desek Coray Carpenter Former name

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
I20160420000667 NC Practitioner - Physician Assistant 7416255799 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Brody School of Medicine at East Carolina University, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCPC-9 LLCGroup PAC ID 1658526710, 57 clinicians
Pinehurst Surgical Clinic PAGroup PAC ID 4587561394, 92 clinicians

Practice addresses (Care Compare)

155 Memorial Dr
Pinehurst, NC 28374-8710

2919 Beechtree Dr
Sanford, NC 27330-6934

5 1St Village Dr
Pinehurst, NC 28374-9495
Phone (910) 295-6831

809 S Long Dr
Rockingham, NC 28379-4377
Phone (910) 417-4096

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-06177NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Scotland Memorial Hospital, Inc CurrentSince Jun 1, 2018 Accepting new patients
MCPC-10, LLC CurrentSince Mar 5, 2016 Accepting new patients
FHPG, LLC Past Accepting new patients
Pinehurst Surgical Clinic PA PastSince Sep 20, 2022 Accepting new patients
Harris Family Practice PLLC Past Accepting new patients

Locations

155 Memorial Dr
Pinehurst, NC 28374
Phone (910) 215-1000

Interoperability endpoints

  • Direct secure messaging: desekgibson@fhss.allscriptsdirect.net

Organizations & group practices 7

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 4

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": "1453939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1144687609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 FIRSTVILLAGE DRIVE",
            "address_2": "PO BOX 2000",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "28374",
            "telephone_number": "910-295-6831",
            "fax_number": "910-295-0244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 FIRSTVILLAGE DRIVE",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "28374",
            "telephone_number": "910-295-6831",
            "fax_number": "910-215-2539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "DESEK",
        "middle_name": "CORAY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-28",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DESEK",
            "last_name": "CARPENTER",
            "middle_name": "CORAY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pinehurst, NC

Sources for this page

Verify at the official NPI Registry.