Pura Clinic Family Medicine PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PURA CLINIC FAMILY MEDICINE PC

Practice address

124 Baywood Rd
Suite 111
Fayetteville, NC 28312-9136

Phone

(910) 829-0143

Fax

(910) 829-5107

NPI assigned

Jan 27, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Mohamad A Shakir, MDNPI 1689792830

Title

Owner/MD

Phone

(910) 829-0143

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Tax ID family

Pura Clinic Family Medicine PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Pura Clinic Family Medicine PC

  • Durable Medical Equipment & Medical Supplies
  • Fayetteville, NC
  • NPI 1164842670
  NPD tax ID
• Pura Clinic Family Medicine PC

  • Urgent Care Clinic/Center
  • Fayetteville, NC
  • NPI 1609296128
  NPD tax ID

Locations

Practitioners 1

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

• Mohamad A Shakir, M.D.

  • Family Medicine Physician
  • Roanoke Rapids, NC
  • NPI 1689792830
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1390780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415577600000",
    "number": "1487077491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 BAYWOOD RD",
            "address_2": "SUITE 111",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283129136",
            "telephone_number": "910-829-0143",
            "fax_number": "910-829-5107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 BAYWOOD RD",
            "address_2": "SUITE 111",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283129136",
            "telephone_number": "910-829-0143",
            "fax_number": "910-829-5107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURA CLINIC FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-27",
        "last_updated": "2014-11-10",
        "status": "A",
        "authorized_official_last_name": "SHAKIR",
        "authorized_official_first_name": "MOHAMAD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "910-829-0143",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487077491",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "148J4",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laci Scenah Punturi
• Jane Lingao Punzalan, NP-C
• Noli Punzalan
• Thomas James Puplava
• Pura Clinic Family Medicine PC
• Pura Clinic Family Medicine PC
• Hester Purcell, LCSW
• Kornelia Wall Purcell, LCAS-A
• Albert Purdie
• Deja Purdie

• Family Medicine Physician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2014; 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.