Organization Active NPI

Waynesville Family Practice Center PA

  • Family Medicine Physician
  • Waynesville, NC
National Provider Identifier
1376631093
Registry record updated Jul 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
40685 Issued in NC
Legal business name
WAYNESVILLE FAMILY PRACTICE CENTER PA
Practice address
1272 East Street
Waynesville, NC 28786-3437
Phone
(828) 456-3511
Fax
(828) 456-3583
NPI assigned
Oct 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2010

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

Authorized official

Name
Michael Wayne Pass, MDNPI 1497843486
Title
President
Phone
(828) 456-3511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 40685 NC Primary

Addresses

Primary practice location

1272 East Street
Waynesville, NC 28786-3437

Mailing address

1272 East Street
Waynesville, NC 28786-3437
Phone (828) 456-3511

Other identifiers 2

IdentifierTypeStateIssuer
8902994MedicaidNC
02994OtherNCBC/BS NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0684908Waynesville Family Practice1272 East Street, Waynesville, NC 28786Certificate of waiverApr 30, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279584000000",
    "number": "1376631093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1272 EAST STREET",
            "city": "WAYNESVILLE",
            "state": "NC",
            "postal_code": "287863437",
            "telephone_number": "828-456-3511",
            "fax_number": "828-456-3583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1272 EAST STREET",
            "city": "WAYNESVILLE",
            "state": "NC",
            "postal_code": "287863437",
            "telephone_number": "828-456-3511",
            "fax_number": "828-456-3583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNESVILLE FAMILY PRACTICE CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2010-07-20",
        "status": "A",
        "authorized_official_last_name": "PASS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "828-456-3511",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "40685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902994",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS NC",
            "identifier": "02994",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waynesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.