Fayetteville Internal Medicine PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

FAYETTEVILLE INTERNAL MEDICINE PLLC

Practice address

1766 Metromedical Dr
Fayetteville, NC 28304-3861

Phone

(910) 483-4856

NPI assigned

Aug 3, 2022

Organization subpart

No

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

Authorized official

Name

Jennifer Fortin

Title

Office Manager

Phone

(910) 483-4680

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 2

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.

• Debbie C Smith, FNP

  • Family Nurse Practitioner
  • Fayetteville, NC
  • NPI 1437827490

  Family Medicine

  Medicare reassignment NPD
• Ann Elizabeth Gilchrist, M.D.

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1144541822

  NC

  Medicare reassignment NPD

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

{
    "created_epoch": "1659484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733097600000",
    "number": "1417684135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1766 METROMEDICAL DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043861",
            "telephone_number": "910-483-4856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1766 METROMEDICAL DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043861",
            "telephone_number": "910-483-4856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE INTERNAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-03",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A",
        "authorized_official_last_name": "FORTIN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "910-483-4680"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fayetteville Gastroenterology Associates, P.a.
• Fayetteville Gastroenterology Endoscopy Center, LLC
• Fayetteville Geriatric & Internal Medicine Clinic PA
• Fayetteville Heart Center, P.C.
• Fayetteville Hyperbarics LLC
• Fayetteville Laser Center PLLC (OrthoLazer)
• Fayetteville Manor, LLC
• Fayetteville Medical Clinic, PC
• Fayetteville NC Homecare LLC (Visiting Angels- Fayetteville, NC)
• Fayetteville Neurology Associates PA

• Family Nurse Practitioner in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; 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.