NPIMap

Individual provider Active NPI

Paul L. Bragg Jr., PA

  • Physician Assistant
  • Fayetteville, NC
National Provider Identifier
1356432280
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001005108 Issued in NC
Practice address
1219 Walter Reed Rd
Fayetteville, NC 28304-4437
Phone
(910) 615-3350
Fax
(910) 321-6253
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001005108 NC Primary

Addresses

Primary practice location

1219 Walter Reed Rd
Fayetteville, NC 28304-4437

Mailing address

1638 Owen Dr
Attn:Managed Care Planning
Fayetteville, NC 28304-3424
Phone (910) 615-6949

Other practice location 1

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-3350

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
I20141031001898 NC Practitioner - Physician Assistant 2668366527 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cape Fear Valley Health Medical Group LLCGroup PAC ID 0648707109, 352 clinicians

Practice addresses (Care Compare)

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 672-0350

4140 Ferncreek Dr
Suite 801
Fayetteville, NC 28314-2572
Phone (910) 484-2171

Hospital & facility affiliations

  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001005108NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cape Fear Valley Health Medical Group LLC CurrentSince Mar 15, 2025 Accepting new patients
Cape Fear Valley Health Medical Group LLC CurrentSince Mar 15, 2025 Accepting new patients
Cape Fear Valley Health Medical Group LLC Physician Assistant Past Accepting new patients
Outreach Professional Services Inc Past Accepting new patients
Lake Hospital System, Inc Past Accepting new patients
Northeastern Ohio Neurosurgical Associates Past Accepting new patients
Gates Road Management, LLC PastSince Jun 1, 2013 Accepting new patients
Lake Hospital System, Inc Past Accepting new patients

Locations

4140 Ferncreek Dr
Ste 801
Fayetteville, NC 28314
Phone (910) 484-2171

1262 Oliver St
Ste B
Fayetteville, NC 28304
Phone (910) 609-4801

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

1219 Walter Reed Rd
Fayetteville, NC 28304
Phone (910) 609-5000

588 Bailey Rd
Ste K
Lumberton, NC 28358
Phone (910) 615-3550

Interoperability endpoints

  • Direct secure messaging: pbragg19120@capefearvalley.direct-ci.com

Organizations & group practices 9

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1356432280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1638 OWEN DR",
            "address_2": "ATTN:MANAGED CARE PLANNING",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043424",
            "telephone_number": "910-615-6949",
            "fax_number": "910-615-9761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 WALTER REED RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044437",
            "telephone_number": "910-615-3350",
            "fax_number": "910-321-6253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1638 Owen Dr",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043424",
            "country_code": "US",
            "telephone_number": "910-615-3350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRAGG",
        "first_name": "PAUL",
        "middle_name": "L.",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001005108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.