NPIMap

Organization Active NPI

Cumberland County Hospital System Inc

Doing business as Westside Medical Care

  • Family Medicine Physician
  • Fayetteville, NC
National Provider Identifier
1386649374
Registry record updated Jan 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CUMBERLAND COUNTY HOSPITAL SYSTEM INC
Doing business as
Westside Medical Care
Practice address
1463 Pamalee Dr
Fayetteville, NC 28303-3974
Phone
(910) 482-3000
Fax
(910) 482-0397
NPI assigned
Jun 16, 2005
Last updated
Jan 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2024

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

Authorized official

Name
Joseph Fiser
Title
Vice President
Phone
(910) 615-5572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1463 Pamalee Dr
Fayetteville, NC 28303-3974

Mailing address

PO Box 40908
Fayetteville, NC 28309-0908
Phone (910) 615-6949

Other identifiers 1

IdentifierTypeStateIssuer
890292AMedicaidNC

Other names 1

  • Westside Medical Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031112000693 NC Part B Supplier - Clinic/Group Practice 1850204041 Receives reassigned benefits from 1,012 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Fayetteville, NC; Lillington, NC; Lumberton, NC; Raeford, NC; Red Springs, NC; Spring Lake, NC; Stedman, NC; Angier, NC…
O20031119000750 NC Part A Provider - Hospital 1850204041 13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stedman, NC; Raeford, NC; Fayetteville, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386649374. Details of each certification follow.

Hospital certification: CCN 340028

Legal name
CUMBERLAND COUNTY HOSPITAL SYSTEM INC
Doing business as
CAPE FEAR VALLEY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 10, 2013
Beds
600 (594 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jul 7, 1964 in NC
Enrollment address
1638 Owen Dr
Fayetteville, NC 28304-3424
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Rehabilitation unit, Other

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

Care Compare: Hospital

Medicare Care Compare
Listed as
Cape Fear Valley Medical CenterCCN 340028 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Henry Culbreath Tyson Individual Corporate DirectorTrustee Dec 1, 2024
Veronica Brunell Jones Individual Corporate DirectorTrustee Dec 31, 2022
Shannon Alane Matthews Individual Corporate DirectorTrustee Dec 31, 2022
Jeannette Council Individual Corporate DirectorTrustee Aug 7, 2000
Ryan Aul Individual Corporate DirectorTrustee Jun 17, 2022
Michael Reesal Jones Individual W-2 Managing EmployeeTrustee Jun 17, 2022
Pamela Suggs Story Individual Corporate DirectorTrustee Dec 31, 2022
Glenn Adams Individual Corporate DirectorTrustee Feb 1, 2016
Moses Y Aboagye Kumi Individual Corporate DirectorTrustee Dec 1, 2024
Girum K Feyissa Individual W-2 Managing EmployeeTrustee Jun 17, 2022
Michael Nagowski Individual Corporate OfficerChief Executive Officer Jan 14, 2008
W-2 Managing EmployeeChief Executive Officer Jan 14, 2008
Sanjay B Shah Individual Corporate DirectorTrustee Dec 31, 2022
Afua Ottie Arhin Individual Corporate DirectorTrustee Sep 1, 2023
Bret Johnson Individual W-2 Managing EmployeeCfo Jun 17, 2022
Myron Scott Strickland Individual Corporate DirectorTrustee Jun 17, 2022
Joseph Fiser Individual Corporate DirectorVP Corp Rev Cycle/Managed Care Feb 12, 2012
W-2 Managing EmployeeVP Corporate Rev Cycle/Managed Care Feb 12, 2012
Ernest West Jones Individual Corporate DirectorTrustee Sep 1, 2023
William Faircloth Individual Corporate DirectorTrustee Dec 22, 2008
Kirk Joseph Deviere Individual Corporate DirectorTrustee Dec 1, 2024
Samuel a Fleishman Individual W-2 Managing EmployeeMedical Director Jun 17, 2022
Kelvin Eric Farmer Individual Corporate DirectorTrustee Dec 1, 2024
Terrill F Brown Individual Corporate DirectorTrustee Sep 1, 2023
Pavi Divyang Patel Individual Corporate DirectorTrustee Dec 1, 2024

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 900

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 900

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1386649374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40908",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283090908",
            "telephone_number": "910-615-6949",
            "fax_number": "910-609-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1463 PAMALEE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283033974",
            "telephone_number": "910-482-3000",
            "fax_number": "910-482-0397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND COUNTY HOSPITAL SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-16",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A",
        "authorized_official_last_name": "FISER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "910-615-5572"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890292A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westside Medical Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.