NPIMap

Organization Active NPI

Wilmington Gastroenterology Endoscopy Center, Inc

  • Ambulatory Surgical Clinic/Center
  • Wilmington, NC
National Provider Identifier
1295948339
Registry record updated Jan 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
AS0091 Issued in NC
Legal business name
WILMINGTON GASTROENTEROLOGY ENDOSCOPY CENTER, INC
Practice address
5115 Oleander Drive
Wilmington, NC 28403-7018
Phone
(910) 362-1011
Fax
(910) 362-1012
NPI assigned
May 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2014

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

Authorized official

Name
Mr. Steven Lee Peterson Jr., MBA
Title
Practice Administrator
Phone
(910) 362-1011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X AS0091 NC Primary

Addresses

Primary practice location

5115 Oleander Drive
Wilmington, NC 28403-7018

Mailing address

5115 Oleander Drive
Wilmington, NC 28403-7018
Phone (910) 362-1011

Other identifiers 1

IdentifierTypeStateIssuer
AS0091OtherNCASC LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070621000082 NC Part B Supplier - Ambulatory Surgical Center 2163315672 Practice locations: Wilmington, NC
O20140210001530 NC Part B Supplier - Ambulatory Surgical Center 0143459305 Practice locations: Wilmington, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Wilmington GastroenterologyCCN 34C0001129
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389225600000",
    "number": "1295948339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5115 OLEANDER DRIVE",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284037018",
            "telephone_number": "910-362-1011",
            "fax_number": "910-362-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 OLEANDER DRIVE",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284037018",
            "telephone_number": "910-362-1011",
            "fax_number": "910-362-1012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON GASTROENTEROLOGY ENDOSCOPY CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2014-01-09",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "910-362-1011",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NC",
            "license": "AS0091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASC LICENSE NUMBER",
            "identifier": "AS0091",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.