Active NPI
Pinehurst Surgical Clinic PA
- Surgery Physician
- Raeford, NC
National Provider Identifier
1275714636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- PINEHURST SURGICAL CLINIC PA
- Practice address
- 6322 Fayetteville Rd
Raeford, NC 28376-7979 - Phone
- (910) 878-6730
- Fax
- (910) 878-6735
- NPI assigned
- Nov 14, 2007
- Last updated
- Sep 13, 2022
- Organization subpart
- Yes
- Parent organization
- PINEHURST SURGICAL CLINIC PA
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Charles Gregg
- Title
- Clinical Informatics Manager
- Phone
- (910) 295-6831
Specialties & licenses 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | |||
| Obstetrics & Gynecology Physician | 207V00000X | |||
| Orthopaedic Surgery Physician | 207X00000X | |||
| Otolaryngology Physician | 207Y00000X | |||
| Physical Medicine & Rehabilitation Physician | 208100000X | |||
| Surgery Physician | 208600000X | Primary | ||
| Vascular Surgery Physician | 2086S0129X | |||
| Urology Physician | 208800000X |
Addresses
Primary practice location
6322 Fayetteville Rd
Raeford, NC 28376-7979
Mailing address
5 First Village Drive
Pinehurst, NC 28374
Phone (910) 295-6831
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031218000239 | NC | Part B Supplier - Clinic/Group Practice | 4587561394 |
Receives reassigned benefits from 132 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fayetteville, NC; Pinehurst, NC; Raeford, NC; Rockingham, NC; Sanford, NC; Southern Pines, NC; Troy, NC |
| O20100930036829 | NC | DME Supplier - Multi-Specialty - Physician | 4587561394 | Practice locations: Raeford, NC |
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Pinehurst Surgical Clinic
- Surgery Physician
- Fayetteville, NC
- NPI 1710609276
4587561394
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Pinehurst Surgical Clinic
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Surgery Physician
- Pinehurst, NC
- NPI 1962434324
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194998400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1663027200000",
"number": "1275714636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 FIRST VILLAGE DRIVE",
"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": "6322 FAYETTEVILLE RD",
"city": "RAEFORD",
"state": "NC",
"postal_code": "283767979",
"telephone_number": "910-878-6730",
"fax_number": "910-878-6735"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PINEHURST SURGICAL CLINIC PA",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PINEHURST SURGICAL CLINIC PA",
"enumeration_date": "2007-11-14",
"last_updated": "2022-09-13",
"certification_date": "2022-09-13",
"status": "A",
"authorized_official_last_name": "GREGG",
"authorized_official_first_name": "CHARLES",
"authorized_official_title_or_position": "CLINICAL INFORMATICS MANAGER",
"authorized_official_telephone_number": "910-295-6831"
},
"taxonomies": [
{
"code": "207T00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Neurological Surgery",
"state": null,
"license": null,
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Otolaryngology",
"state": null,
"license": null,
"primary": false
},
{
"code": "208100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Medicine & Rehabilitation",
"state": null,
"license": null,
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
},
{
"code": "2086S0129X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery, Vascular Surgery",
"state": null,
"license": null,
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Urology",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raeford, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.