NPIMap

Organization Active NPI

The Pediatric Practice

  • Pediatrics Physician
  • Fayetteville, NC
National Provider Identifier
1376535799
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
H0213 Issued in NC
Legal business name
THE PEDIATRIC PRACTICE
Practice address
101 Robeson St
Suite 300
Fayetteville, NC 28301-5552
Phone
(910) 609-1616
Fax
(910) 609-1619
NPI assigned
Aug 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Richard H Parks
Title
Ceo
Phone
(910) 609-6700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X H0213 NC Primary

Addresses

Primary practice location

101 Robeson St
Suite 300
Fayetteville, NC 28301-5552

Mailing address

PO Box 41209
Fayetteville, NC 28309-1209
Phone (910) 609-6448

Other identifiers 1

IdentifierTypeStateIssuer
790236CMedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Cumberland County EMS50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

Organizations that report the same tax identification number in the National Provider Directory.

View all 49

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376535799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41209",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283091209",
            "telephone_number": "910-609-6448",
            "fax_number": "910-609-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 ROBESON ST",
            "address_2": "SUITE 300",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015552",
            "telephone_number": "910-609-1616",
            "fax_number": "910-609-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-609-6700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "H0213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790236C",
            "state": "NC"
        }
    ],
    "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.