Vidant Medical Group Affiliates LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

VIDANT MEDICAL GROUP AFFILIATES LLC

Practice address

2100 Stantonsburg Rd
Greenville, NC 27834-2818

Phone

(252) 847-2181

Fax

(252) 847-2213

NPI assigned

Jan 23, 2015

Last updated

Jun 7, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

VIDANT MEDICAL GROUP LLCAs reported in NPPES

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

Authorized official

Name

Mr. Andrew K Zukowski

Title

Cfo

Phone

(252) 847-4582

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Part of

Vidant Medical Group LLC

Locations

Practitioners 43

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.

• Caroline Dorothea Ames, M.D.

  • Urology Physician
  • Greenville, NC
  • NPI 1699861096
  Medicare reassignment NPD
• Kelechi Aruogu

  • Internal Medicine Physician
  • Whiteville, NC
  • NPI 1366790834
  Medicare reassignment NPD
• Rosiland Dixon Buck, FNP, MSN

  • Nurse Practitioner
  • Greenville, NC
  • NPI 1578782819
  Medicare reassignment NPD
• Matthew Alan Collins, MD

  • Urology Physician
  • Greenville, NC
  • NPI 1649392853
  Medicare reassignment NPD
• George Crowl, MD

  • Physical Medicine & Rehabilitation Physician
  • Greenville, NC
  • NPI 1770540296
  Medicare reassignment NPD
• Robert Dietrich, MD

  • Pulmonary Disease Physician
  • Greenville, NC
  • NPI 1871596932
  Medicare reassignment NPD
• David L Fairbrother, MD

  • Pediatric Cardiology Physician
  • Greenville, NC
  • NPI 1710961164
  Medicare reassignment NPD
• Marquita Morris Fields, NP

  • Family Nurse Practitioner
  • Charlotte, NC
  • NPI 1407413040
  Medicare reassignment NPD
• John Patrick Fogarty, MD

  • Pulmonary Disease Physician
  • Greenville, NC
  • NPI 1033112081
  Medicare reassignment NPD
• David W Frazier, MD

  • Clinical Cardiac Electrophysiology Physician
  • Greenville, NC
  • NPI 1114076395
  Medicare reassignment NPD
• Teresa Gross, F.N.P.

  • Family Nurse Practitioner
  • Greenville, NC
  • NPI 1629287610
  Medicare reassignment NPD
• Jonathan Nathaniel Hamilton, M.D.

  • Urology Physician
  • Greenville, NC
  • NPI 1609965508
  Medicare reassignment NPD

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

{
    "created_epoch": "1421971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686096000000",
    "number": "1437549896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 STANTONSBURG RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342818",
            "telephone_number": "252-847-2181",
            "fax_number": "252-847-2213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 STANTONSBURG RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342818",
            "telephone_number": "252-847-2181",
            "fax_number": "252-847-2213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDANT MEDICAL GROUP AFFILIATES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VIDANT MEDICAL GROUP LLC",
        "enumeration_date": "2015-01-23",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A",
        "authorized_official_last_name": "ZUKOWSKI",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "252-847-4582",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blair Willis Vick, MS, CCC-SLP
• Elnora Linda Vick
• Susan Burch Vick, PTA
• Virginia McRoy Vickery, M.S.
• Jacquelin Nicole Victory, RN
• Vidant Medical Group LLC
• Vidant Medical Group LLC (Vidant Urology-Greenville)
• Vidant Radiation Oncology LLC
• Sean Carl Vidulich, DO
• Alexandre Rezende Vieira

• Multi-Specialty Clinic/Center in Greenville, NC
• Providers in Greenville, NC by specialty
• Multi-Specialty Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; 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.