NPIMap

Individual provider Active NPI

Gajarah Baseemah Ballard Peterson, M.D.

  • Internal Medicine Physician
  • Wilmington, NC
National Provider Identifier
1467626788
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2011-00839 Issued in NC
Practice address
1202 Medical Center Dr
Wilmington, NC 28401-7307
Phone
(910) 341-3300
Fax
(910) 251-8824
NPI assigned
Apr 17, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 2011-00839 NC
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 2011-00839 NC Primary

Addresses

Primary practice location

1202 Medical Center Dr
Wilmington, NC 28401-7307

Mailing address

1202 Medical Center Dr
Wilmington, NC 28401-7307
Phone (910) 341-3300

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
I20110817000568 NC Practitioner - HospitalistPractitioner - Internal Medicine 2264601780 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of North Carolina at Chapel Hill School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
NM Pacs 2 LLCGroup PAC ID 3375892060, 108 clinicians
Inpatient Consultants of North Carolina PCGroup PAC ID 5991720591, 85 clinicians
CS Pacs 3 Southeast LLCGroup PAC ID 8426404302, 129 clinicians

Practice addresses (Care Compare)

3015 Enterprise Dr
Wilmington, NC 28405-2116
Phone (910) 791-3451

515 Barbour Rd
Smithfield, NC 27577-7698
Phone (919) 934-6017

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
NM Pacs 2 LLC Hospitalist CurrentSince Aug 1, 2023 Accepting new patients
Columbus Regional Health Network Internal Medicine Current Accepting new patients
Inpatient Consultants of North Carolina, PC Internal Medicine CurrentSince Aug 1, 2023 Accepting new patients
Columbus Regional Health Network CurrentSince Jan 6, 2020 Accepting new patients
Carolinas Physicians Network Inc Internal Medicine CurrentSince Jan 6, 2020 Accepting new patients
Scotland Regional Health Network Internal Medicine Current Accepting new patients
Scotland Regional Health Network CurrentSince Jan 6, 2020 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Scotland Regional Health Network CurrentSince Jan 6, 2020 Accepting new patients
Columbus Regional Health Network Internal Medicine CurrentSince Jan 6, 2020 Accepting new patients
CS Pacs 3 Southeast, LLC Hospitalist CurrentSince Aug 1, 2024 Accepting new patients
Inpatient Consultants of North Carolina, PC Internal Medicine CurrentSince Aug 1, 2023 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jan 6, 2020 Accepting new patients
Liberty Healthcare Group LLC Past Accepting new patients
Columbus Regional Health Network Internal Medicine Past Accepting new patients
Wilmington Health PLLC Past Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

707 N Elm St
High Point, NC 27262
Phone (336) 885-0141

500 Lauchwood Dr
Laurinburg, NC 28352
Phone (856) 848-3227

204 E Old Highway 74
Monroe, NC 28112
Phone (704) 283-3066

600 Hospital Dr
Monroe, NC 28112
Phone (704) 283-3100

515 Barbour Rd
Smithfield, NC 27577
Phone (919) 227-6261

179 Combs St
Sparta, NC 28675
Phone (336) 372-2441

500 Jefferson St
Whiteville, NC 28472
Phone (910) 642-1776

612 Jefferson St
#28
Whiteville, NC 28472
Phone (910) 640-4064

3015 Enterprise Dr
Wilmington, NC 28405
Phone (910) 791-3451

1011 Porters Neck Rd
Wilmington, NC 28411
Phone (910) 686-7195

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Liberty Commons Nursing & Rehabilitation Center of Southport LLCSouthport, NC, CCN 345373 Skilled nursing facility Operational/Managerial Control Apr 29, 2025
Pinehurst Healthcare and Rehabilitation CenterPinehurst, NC, CCN 345370 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 4, 2025
Dec 4, 2025

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1467626788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017307",
            "telephone_number": "910-341-3300",
            "fax_number": "910-251-8824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017307",
            "telephone_number": "910-341-3300",
            "fax_number": "910-251-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "GAJARAH",
        "middle_name": "BASEEMAH BALLARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-17",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NC",
            "license": "2011-00839",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2011-00839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.