Pediatric Practice

Primary specialty

Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X

License

H0213 Issued in NC

Legal business name

PEDIATRIC PRACTICE

Practice address

101 Robeson St Ste 410
Fayetteville, NC 28301-5520

Phone

(910) 615-1885

Fax

(910) 321-6254

NPI assigned

Jun 26, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Michael Nagowski

Title

Ceo

Phone

(910) 609-6700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cape Fear Valley Pediatric Endocrinology Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Cumberland County Hospital System Inc

  • Diagnostic Radiology Physician
  • Fayetteville, NC
  • NPI 1962299743

  Member Of

  NPD member

Practitioners 3

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

• Brunilda Cordero, MD

  • Pediatric Endocrinology Physician
  • Fayetteville, NC
  • NPI 1619074408
  Medicare reassignment NPD
• Ruth S Faircloth, MD

  • Pediatric Endocrinology Physician
  • Fayetteville, NC
  • NPI 1851561112
  Medicare reassignment NPD
• Bradley James Broussard, M.D.

  • Orthopaedic Surgery Physician
  • Fayetteville, NC
  • NPI 1457325110
  NPD (past)

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738281600000",
    "number": "1396907903",
    "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 STE 410",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015520",
            "telephone_number": "910-615-1885",
            "fax_number": "910-321-6254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-26",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A",
        "authorized_official_last_name": "NAGOWSKI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-609-6700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "NC",
            "license": "H0213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cape Fear Valley Pediatric Endocrinology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cape Fear Valley Pediatric Endocrinology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ernest Neergaard Pedersen, LCSW
• Pediatric After Hours Care of Fayetteville
• Pediatric Developmental Therapy
• Pediatric Developmental Therapy
• Pediatric Partners of NC, Inc
• Pediatric Services of America, LLC
• Hannah Jamie Elyse Peevy, RN, NP, MS
• Harley Pelaez Gaona
• Cesar Pelaez, DMD
• Pelham Home Health Services, Inc

• Pediatric Endocrinology Physician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Pediatric Endocrinology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.