Michael D Watson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-13830 Issued in NC

Practice address

113 Kite Cir NE
Bolivia, NC 28422-3805

Phone

(907) 885-7779

NPI assigned

Aug 19, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fastmed PCGroup PAC ID 9830540558, 174 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
• Direct secure messaging: mwatson3048212@carolinashealthcaresystem.direct-ci.com

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.

• Fastmed P.C.

  • Family Medicine Physician
  • Durham, NC
  • NPI 1629841788
  Medicare reassignment Care Compare group
• North Carolina Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Laurinburg, NC
  • NPI 1003861386
  Medicare reassignment NPD
• Carolina Quickcare Family Practice, PLLC

  • Internal Medicine Physician
  • Biscoe, NC
  • NPI 1881360899
  Medicare reassignment
• Fastmed Primary Care, P.C.

  • Family Medicine Physician
  • Fayetteville, NC
  • NPI 1912774423
  NPD (past)

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

{
    "created_epoch": "1660867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1407574056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 KITE CIR NE",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284223805",
            "telephone_number": "907-885-7779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 KITE CIR NE",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284223805",
            "telephone_number": "907-885-7779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Francam Dr Ste 120",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283114500",
            "country_code": "US",
            "telephone_number": "910-487-1100",
            "fax_number": "910-884-9821",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-19",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-13810",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-13830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "0010-13830",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miller J Van Vliet, DO
• Hannah Leann Vaughn, M.A., CCC-SLP
• Erin Nicole Wallace
• Jonathan Ward, M.D.
• Olivia Wardlaw, LCSWA
• Kara Anne Weatherford, FNP
• Ryleigh Weber, MS
• Carolyn Whitfield
• Lillie Williams, LCAS-A
• Ryan Williams

• Physician Assistant in Bolivia, NC
• Providers in Bolivia, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; 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.

Verify at the official NPI Registry.