Pinehurst Surgical Clinic PA
Organization Active NPI Surgery Physician · Raeford, NC
NPI 1275714636 · NPPES record last updated Sep 13, 2022
Key facts
- NPI
- 1275714636
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- 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
- Organization subpart
- Yes
- Parent organization (as reported)
- PINEHURST SURGICAL CLINIC PA
Authorized official
- Name
- Charles Gregg
- Title
- Clinical Informatics Manager
- Phone
- (910) 295-6831
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 3
Practitioners 92
-
Olufunsho Adamolekun, D.O
-
Fabian E Alzamora, M.D.
-
Clinton Kesler Atkinson, M.D.
-
Steve Balos, NP
-
Raymond Tyler Beaman, PA-C
-
Carl W Berk, M.D.
-
Robert A Bibey, PA-C
-
Kristin A Blatz, PA-C
-
Mark Earl Brenner, M.D.
-
Jena Burkhart, PT
-
Brian Scott Burlingame, M.D.
-
McKenley Landris Byrd, PT, DPT
-
David Joseph Casey, M.D.
-
Savannah Grace Chappell, PA-C
-
Andrew David Coggin, M.D.
-
Chad Allen Cole, P.A.
-
Neil A Conti, M.D.
-
Gerald Crist, PA
-
Benjamin Demeyere, PA-C
-
Mara Duncan, PA-C
-
Heather Ann Evans, AU.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Medicare enrollment records
| 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 |
National Provider Directory
- Part of
- Pinehurst Surgical Clinic
Specialties & licenses
| 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 | Yes | ||
| 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
Other providers in Raeford, NC
- Jettie Mae Patterson
- Stephan Patterson
- Rhonda Peterson
- Brooke Phelps
- Yvette Josephine Piantadosi
- Pinnacle Family Services of North Carolina LLC
- Melanie Ann Pitts
- Markida Shi'Dae Pointer
- Andrea Potter
- Potter'S House Outreach Corporation
All providers in Raeford, NC · Surgery Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.