Active NPI
Robert Maughan
- Medical Physician Assistant
- Fayetteville, NC
National Provider Identifier
1245860618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 1638 Owen Drive
Fayetteville, NC 28304-3424 - Phone
- (910) 615-8000
- NPI assigned
- Jan 24, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | Primary |
Addresses
Primary practice location
1638 Owen Drive
Fayetteville, NC 28304-3424
Mailing address
129 Bryce Creek LN
Fayetteville, NC 28303-4981
Phone (910) 366-3796
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200824000081 | NC | Practitioner - Physician Assistant | 5496171365 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757030400000",
"number": "1245860618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "129 BRYCE CREEK LN",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283034981",
"telephone_number": "910-366-3796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1638 OWEN DRIVE",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043424",
"telephone_number": "910-615-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAUGHAN",
"first_name": "ROBERT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-24",
"last_updated": "2025-09-05",
"certification_date": "2025-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"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 Sep 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.