NPIMap

Organization Active NPI

Surgical Medical Clinic

  • Surgery Physician
  • Burgaw, NC
National Provider Identifier
1417378779
Registry record updated Jan 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
19763 Issued in NC
Legal business name
SURGICAL MEDICAL CLINIC
Practice address
407 East Fremont Street
Burgaw, NC 28425-0729
Phone
(910) 259-2161
Fax
(910) 259-7870
NPI assigned
Jan 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2014

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

Authorized official

Name
Dr. Naseem H Nasrallah, M.D
Title
Owner
Phone
(910) 259-2161

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X 19763 NC Primary
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X 5005024 NC

Addresses

Primary practice location

407 East Fremont Street
Burgaw, NC 28425-0729

Mailing address

PO Box 729
Burgaw, NC 28425-0729
Phone (910) 259-2161

Other identifiers 2

IdentifierTypeStateIssuer
7961886MedicaidNC
1235445982OtherNCNC MEDICARE AND MEDICAID # PENDING FOR NPI # 1235445982

Other names 1

  • Dr Naseem Nasrallah Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1388707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388707200000",
    "number": "1417378779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 729",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "284250729",
            "telephone_number": "910-259-2161",
            "fax_number": "910-259-7870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 EAST FREMONT STREET",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "284250729",
            "telephone_number": "910-259-2161",
            "fax_number": "910-259-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-03",
        "last_updated": "2014-01-03",
        "status": "A",
        "authorized_official_last_name": "NASRALLAH",
        "authorized_official_first_name": "NASEEM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-259-2161",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "NC",
            "license": "19763",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NC",
            "license": "5005024",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7961886",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC MEDICARE AND MEDICAID # PENDING FOR NPI # 1235445982",
            "identifier": "1235445982",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Naseem Nasrallah",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Burgaw, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.