Organization Active NPI

Agape Orthotics of NC

  • Prosthetic/Orthotic Supplier
  • Fayetteville, NC
National Provider Identifier
1164005385
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
AGAPE ORTHOTICS OF NC
Practice address
2139 Valleygate Dr Ste 101a
Fayetteville, NC 28304-3666
Phone
(910) 574-9804
NPI assigned
May 5, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Authorized official

Name
Ciprian Pufulete, CPEDNPI 1750044392
Title
Manager
Phone
(910) 574-9804

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OrthotistGroup: 193400000X SINGLE SPECIALTY GROUP 222Z00000X
Durable Medical Equipment & Medical Supplies 332B00000X
Customized Equipment (DME) 332BC3200X
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

2139 Valleygate Dr Ste 101a
Fayetteville, NC 28304-3666

Mailing address

PO Box 58296
Fayetteville, NC 28305-8296
Phone (910) 574-9804

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210622000839 NC DME Supplier - Pedorthic Personnel 9638570146 Practice locations: Fayetteville, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Agape Orthotics of NC2139 Valleygate Dr, Fayetteville, NC 28304-3666(910) 500-3264 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Surgical Dressings|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Accepts assignmentParticipating since Aug 9, 2021

National Provider Directory

National Provider Directory

Locations

25 Amarillo Ln
Sanford, NC 27332

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1620172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1164005385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 58296",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283058296",
            "telephone_number": "910-574-9804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2139 VALLEYGATE DR STE 101A",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043666",
            "telephone_number": "910-574-9804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAPE ORTHOTICS OF NC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-05",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "PUFULETE",
        "authorized_official_first_name": "CIPRIAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "910-574-9804",
        "authorized_official_credential": "CPED"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthotist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.