NPIMap

Organization Active NPI

Carolina Adult Medicine, PA

  • Geriatric Medicine (Internal Medicine) Physician
  • Henderson, NC
National Provider Identifier
1477512812
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
9701734 Issued in NC
Legal business name
CAROLINA ADULT MEDICINE, PA
Practice address
568 Ruin Creek Rd
Suite 002
Henderson, NC 27536-2880
Phone
(252) 438-7777
Fax
(252) 438-7190
NPI assigned
Mar 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mark John Gruchacz, M.D.NPI 1659364115
Title
President
Phone
(252) 438-7777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 9700258 NC
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X 9701734 NC Primary

Addresses

Primary practice location

568 Ruin Creek Rd
Suite 002
Henderson, NC 27536-2880

Mailing address

568 Ruin Creek Rd
Suite 002
Henderson, NC 27536-2880
Phone (252) 438-7777

Other identifiers 2

IdentifierTypeStateIssuer
016G2OtherNCBCBS GROUP NUMBER
89016G2MedicaidNC

National Provider Directory

National Provider Directory

Locations

568 Ruin Creek Rd
Ste 2
Henderson, NC 27536
Phone (252) 438-7777

Practitioners & affiliated clinicians

Practitioners 3

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": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1477512812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 RUIN CREEK RD",
            "address_2": "SUITE 002",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275362880",
            "telephone_number": "252-438-7777",
            "fax_number": "252-438-7190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "568 RUIN CREEK RD",
            "address_2": "SUITE 002",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275362880",
            "telephone_number": "252-438-7777",
            "fax_number": "252-438-7190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA ADULT MEDICINE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "GRUCHACZ",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-438-7777",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9700258",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NC",
            "license": "9701734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "016G2",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016G2",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.