Active NPI
Elijah Engwall
- Family Medicine Physician
- Wilmington, NC
National Provider Identifier
1386131639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2021-00517
- Practice address
- 1124 Gallery Park Boulevard
Wilmington, NC 28412 - Phone
- (910) 341-1544
- NPI assigned
- Apr 21, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 2021-00517 | NC | Primary |
Addresses
Primary practice location
1124 Gallery Park Boulevard
Wilmington, NC 28412
Mailing address
1202 Medical Center Dr
Wilmington, NC 28401-7307
Phone (910) 341-1544
Other practice location 1
809 82nd Pkwy
Myrtle Beach, SC 29572-4607
Phone (843) 848-4679
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Edward Via Col of Osteo Medicine-Carolinas Campus, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Legacy Healthcare Services Inc
Practice addresses (Care Compare)
1124 Gallery Park LN
Wilmington, NC 28412-1142
Phone (910) 341-1540
2701 Pickett Rd
Durham, NC 27705-5688
Phone (919) 419-9600
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021-00517 | NC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wilmington Health PLLC | Current | Accepting new patients | |
| Wha Medical Clinic PLLC | Current | Accepting new patients | |
| Wilmington Health PLLC | Current | Accepting new patients | |
| Wilmington ASC LLC | Current | Accepting new patients |
Locations
1124 Gallery Park Ln
Wilmington, NC 28412
Phone (910) 341-3389
1202 Medical Center Dr
Wilmington, NC 28401
Phone (910) 617-6705
Interoperability endpoints
- eengwall1245605@direct.novanthealth.org
- elijah.engwall.p1@direct.wilmingtonhealth.nextgenshare.com
- elijah.engwall@hca5.eclinicaldirectplus.com
Organizations & group practices 4
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.
-
- Multi-Specialty Clinic/Center
- Wilmington, NC
- NPI 1881632339
-
- Endoscopy Clinic/Center
- Wilmington, NC
- NPI 1083889091
-
dba Wilmington Health Ambulatory Surgery Center
- Ambulatory Surgical Clinic/Center
- Wilmington, NC
- NPI 1548456478
-
- Non-Pharmacy Dispensing Site
- Wilmington, NC
- NPI 1851054803
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Novant Health New Hanover Regional Medical Center
- General Acute Care Hospital
- Wilmington, NC
- NPI 1376139139
-
- Home Health Agency
- Wilmington, NC
- NPI 1760470660
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628208000000",
"number": "1386131639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1202 MEDICAL CENTER DR",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284017307",
"telephone_number": "910-341-1544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1124 GALLERY PARK BOULEVARD",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "28412",
"telephone_number": "910-341-1544"
}
],
"practiceLocations": [
{
"address_1": "809 82nd Pkwy",
"address_purpose": "LOCATION",
"city": "Myrtle Beach",
"state": "SC",
"postal_code": "295724607",
"country_code": "US",
"telephone_number": "843-848-4679",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ENGWALL",
"first_name": "ELIJAH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-21",
"last_updated": "2021-08-06",
"certification_date": "2021-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "2021-00517",
"primary": true
}
],
"identifiers": [],
"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 Aug 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.