NPIMap

Individual provider Active NPI

Scott Christopher Ganucheau, MSPAS, PA-C, ATC

  • Physician Assistant
  • Shallotte, NC
National Provider Identifier
1215344619
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-12026 Issued in NC
Practice address
5145 Sellers Rd
Shallotte, NC 28470-3405
Phone
(910) 754-4441
Fax
(910) 754-5307
NPI assigned
Jul 17, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 661 SC
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X NC
Physician Assistant 363A00000X 0010-12026 NC Primary

Addresses

Primary practice location

5145 Sellers Rd
Shallotte, NC 28470-3405

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

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
I20220317002699 NC Practitioner - Physician Assistant 1153716774 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, shared by 14 NPIs, 2,413 clinicians

Practice addresses (Care Compare)

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200

5145 Sellers Rd
Shallotte, NC 28470-3405

Hospital & facility affiliations

  • Well Care Home Health Home health agency, Wilmington, NC, CCN 347002
  • Novant Health Brunswick Medical Center Hospital, Supply, NC, CCN 340158
  • Novant Health New Hanover Regional Medical Center Hospital, Wilmington, NC, CCN 340141

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
661SCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Multi-Specialty CurrentSince Feb 7, 2022 Accepting new patients
Novant Health Medical Group, LLC Multi-Specialty CurrentSince Feb 1, 2023 Accepting new patients
Novant Health Medical Group, LLC Multi-Specialty CurrentSince Feb 7, 2022 Accepting new patients
Novant Health Medical Group, LLC Multi-Specialty Past Accepting new patients

Locations

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: sganucheau900556@direct.novanthealth.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1405555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1215344619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5145 SELLERS RD",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284703405",
            "telephone_number": "910-754-4441",
            "fax_number": "910-754-5307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANUCHEAU",
        "first_name": "SCOTT",
        "middle_name": "CHRISTOPHER",
        "credential": "MSPAS, PA-C, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-17",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "SC",
            "license": "661",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shallotte, NC

Sources for this page

Verify at the official NPI Registry.