Fayetteville Gastroenterology Associates, P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

AS0071 Issued in NC

Legal business name

FAYETTEVILLE GASTROENTEROLOGY ASSOCIATES, P.A.

Practice address

2041 Valleygate Dr
Fayetteville, NC 28304-3688

Phone

(910) 323-5203

Fax

(910) 323-3650

NPI assigned

Jul 29, 2006

Organization subpart

No

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

Authorized official

Name

Dr. William F Vorder Bruegge, MDNPI 1548293855

Title

Owner

Phone

(910) 323-5203

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Fayetteville Gastroenterology Associates, P.a.

  • Endoscopy Clinic/Center
  • Fayetteville, NC
  • NPI 1417141623
  NPPES parent name

Practitioners 10

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

• William F. Vorder Bruegge, M.D.

  • Gastroenterology Physician
  • Fayetteville, NC
  • NPI 1548293855
  Medicare reassignment NPD Authorized official
• Anthony M Daniels, MD

  • Gastroenterology Physician
  • Fayetteville, NC
  • NPI 1558398511
  Medicare reassignment NPD
• Joseph Bernard Henderson, D.O.

  • Gastroenterology Physician
  • Fayetteville, NC
  • NPI 1790963759
  Medicare reassignment NPD
• Juan Gilberto Herrera, MD

  • Gastroenterology Physician
  • Raleigh, NC
  • NPI 1841282118
  Medicare reassignment NPD
• Arvind Kumar, M.D.

  • Gastroenterology Physician
  • Fayetteville, NC
  • NPI 1508882325
  Medicare reassignment NPD
• John E. Poulos, M.D.

  • Gastroenterology Physician
  • Fayetteville, NC
  • NPI 1578596896
  Medicare reassignment NPD
• Valli P. Kodali, M.D.

  • Gastroenterology Physician
  • New Orleans, LA
  • NPI 1609809920

  NC

  Medicare reassignment NPD
• Thomas H Daignault, PA

  • Physician Assistant
  • Fayetteville, NC
  • NPI 1922080605
  Medicare reassignment
• Kathryn Vreeland Locklear, PA-C

  • Physician Assistant
  • Fayetteville, NC
  • NPI 1316130867
  Medicare reassignment
• Jill Rys, PA-C

  • Physician Assistant
  • Fayetteville, NC
  • NPI 1922080944
  Medicare reassignment

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618358400000",
    "number": "1457365751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 VALLEYGATE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043688",
            "telephone_number": "910-323-5203",
            "fax_number": "910-323-3650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 VALLEYGATE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043688",
            "telephone_number": "910-323-5203",
            "fax_number": "910-323-3650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE GASTROENTEROLOGY ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2021-04-14",
        "certification_date": "2021-02-11",
        "status": "A",
        "authorized_official_last_name": "VORDER BRUEGGE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-323-5203",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "AS0071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0191J",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890191J",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Fayetteville Foot and Ankle Center
• 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 Internal Medicine PLLC

• Specialist in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; 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.