NPIMap

Individual provider Active NPI

Jose Gerardo Vergara, M.D.

  • Family Medicine Physician
  • Elizabethtown, NC
National Provider Identifier
1194796920
Registry record updated Apr 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2017-02435 Issued in NC
Practice address
300A E McKay St
Elizabethtown, NC 28337-9037
Phone
(910) 862-5500
Fax
(910) 862-5501
NPI assigned
Jan 30, 2006
Last updated
Apr 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2017-02435 NC Primary
Internal Medicine Physician 207R00000X MD19527 ME
Gastroenterology Physician 207RG0100X A55692 CA

Addresses

Primary practice location

300A E McKay St
Elizabethtown, NC 28337-9037

Mailing address

PO Box 40908
Fayetteville, NC 28309-0908
Phone (910) 615-6949

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
I20180119000367 NC Practitioner - Internal Medicine 3476708942 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bladen Healthcare LLCGroup PAC ID 6800967969, 41 clinicians

Practice addresses (Care Compare)

107 E Dunham St
Elizabethtown, NC 28337-4300
Phone (910) 862-2122

300 A E McKay St
Elizabethtown, NC 28337-9037
Phone (910) 862-6672

501 S Poplar St
Elizabethtown, NC 28337-9375
Phone (910) 862-1276

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD19527MEMDInternal Medicine Physician
A55692CAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bladen Healthcare, LLC Family Medicine CurrentSince Dec 11, 2017 Accepting new patients
Bladen Healthcare LLC Current Accepting new patients
Bladen Healthcare LLC CurrentSince Dec 11, 2017 Accepting new patients

Locations

107 E Dunham St
Elizabethtown, NC 28337
Phone (910) 615-3200

273 White Lake Dr
Elizabethtown, NC 28337
Phone (910) 862-1265

300A E McKay St
Elizabethtown, NC 28337
Phone (910) 862-5500

501 S Poplar St
Elizabethtown, NC 28337
Phone (910) 862-4043

Interoperability endpoints

  • Direct secure messaging: jvergara16380@capefearvalley.direct-ci.com

Organizations & group practices 3

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 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776384000000",
    "number": "1194796920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40908",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283090908",
            "telephone_number": "910-615-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300A E MCKAY ST",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283379037",
            "telephone_number": "910-862-5500",
            "fax_number": "910-862-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERGARA",
        "first_name": "JOSE",
        "middle_name": "GERARDO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2017-02435",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ME",
            "license": "MD19527",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A55692",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, NC

Sources for this page

Verify at the official NPI Registry.