NPIMap

Individual provider Active NPI

Jennifer Irene Sturcken, PA-C

  • Medical Physician Assistant
  • Fayetteville, NC
National Provider Identifier
1407887219
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0010-00389 Issued in NC
Practice address
609 Executive PL Ste B
Fayetteville, NC 28305-5713
Phone
(910) 677-9488
Fax
(866) 694-9185
NPI assigned
Jul 6, 2006
Reactivated
Jan 25, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0010-00389 NC Primary

Addresses

Primary practice location

609 Executive PL Ste B
Fayetteville, NC 28305-5713

Mailing address

609 Executive PL Ste B
Fayetteville, NC 28305-5713
Phone (910) 677-9488

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070927000718 NC Practitioner - Physician Assistant 0143315796 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Physical Therapy Associates LLCGroup PAC ID 7012989684, shared by 7 NPIs, 496 clinicians

Practice addresses (Care Compare)

609 Executive PL
Suite B
Fayetteville, NC 28305-5713
Phone (910) 677-9488

609 Executive PL B
Fayetteville, NC 28305-5713

721 Tilghman Dr
Suite 100
Dunn, NC 28334-6066
Phone (910) 892-5635

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-00389NCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Coast Emergency Physicians LLC Past Accepting new patients
Solas Health PLLC PastSince May 30, 2023 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BGFABD/Endpoint/BGFABD

Organizations & group practices 5

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1407887219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 EXECUTIVE PL STE B",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055713",
            "telephone_number": "910-677-9488",
            "fax_number": "866-694-9185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 EXECUTIVE PL STE B",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055713",
            "telephone_number": "910-677-9488",
            "fax_number": "866-694-9185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STURCKEN",
        "first_name": "JENNIFER",
        "middle_name": "IRENE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "deactivation_date": "2024-01-17",
        "reactivation_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-00389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.