Walter S Fasolak, DO
Individual provider Active NPI Obstetrics & Gynecology Physician · Southern Pines, NC
NPI 1497716211 · NPPES record last updated Feb 25, 2010
Key facts
- NPI
- 1497716211
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 39728 (NC)
- Practice address
- 145 Applecross Rd
Southern Pines Womens Health Center PC
Southern Pines, NC 28387 - Phone
- (910) 692-7928
- Fax
- (910) 692-5962
- NPI assigned
- Mar 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 5
Owned or controlled facilities with NPI records 7
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Kansas City University of Physicians and Surgeons, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- MCPC-12 LLC
Practice addresses (Care Compare)
145 Applecross Rd
Pinehurst, NC 28374-8521
Phone (910) 692-7928
Hospital & facility affiliations
- Firsthealth Moore Regional Hospital
- Firsthealth Montgomery Memorial Hosp
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.49 of 100
- Quality
- 98.47
- Promoting interoperability
- 81
- Improvement activities
- 40
- Cost
- 88.99
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.61 of 100
- Quality
- 93.9
- Promoting interoperability
- 91
- Improvement activities
- 40
- Cost
- 85.33
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal or shaving of skin growth | 1-10 |
| Removal of the uterus | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Firsthealth Montgomery Memorial Hospital |
Hospital | Corporate Director Operational/Managerial Control |
Dec 7, 2004 Sep 18, 2012 |
| Firsthealth Moore Regional Hospital Rehab |
Hospital | Corporate Director Operational/Managerial Control |
Nov 17, 2011 Nov 17, 2011 |
| Firsthealth Montgomery Memorial Hospital |
Skilled nursing facility | Corporate Director Operational/Managerial Control |
Nov 14, 2011 Nov 14, 2011 |
| First Health Home Care |
Home health agency | Corporate Director | Sep 15, 2010 |
| First Health Home Care - Richmond |
Home health agency | Corporate Director | Aug 10, 2010 |
| Firsthealth Hospice and Palliative Care |
Hospice | Corporate Director | Oct 9, 2002 |
| Firsthealth Montgomery Memorial Hospital |
Rural health clinic | Corporate Director | Sep 1, 2008 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100430000706 | NC | Practitioner - Obstetrics/Gynecology | 1759339757 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MCPC-7, LLC | Current |
Accepting new patients | |
| MCPC-12, LLC | Obstetrics & Gynecology | Current |
Accepting new patients |
| MCPC-12, LLC | Current |
Accepting new patients | |
| FHPG, LLC | Past |
Accepting new patients | |
| FHPG, LLC | Past | Accepting new patients |
Locations
104 Rice St
Hamlet, NC 28345
Phone (910) 582-4003
5 First Village Dr
Ste 100
Pinehurst, NC 28374
Phone (910) 692-7928
46 Memorial Dr
Pinehurst, NC 28374
Phone (910) 295-6782
313 Teal Dr
Raeford, NC 28376
Phone (910) 904-2350
110 Medical Cir
Rockingham, NC 28379
Phone (910) 410-9494
Interoperability endpoints
- wfasolak@spwhc.gwaydirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 39728 | NC | Yes |
Addresses
Primary practice location
145 Applecross Rd
Southern Pines Womens Health Center PC
Southern Pines, NC 28387
Mailing address
PO Box 749
Southern Pines Womens Health Center PC
Southern Pines, NC 28388-0749
Phone (910) 692-7928
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8931369 | Medicaid | NC | |
| Q39728 | Medicaid | SC | |
| 31369 | Other | BLUE CROSS BLUE SHIELD | |
| 9663436 | Other | GHI | |
| 980000066 | Other | MEDICARE RAILROAD | |
| FH1000115 | Other | FIRST CAROLINA CARE | |
| 42653 | Other | MEDCOST |
Other providers in Southern Pines, NC
- Amy Christina Ewald
- Chelsea Marie Fairley
- Anna Frances Fakadej
- Family & Co Chiropractic, PLLC
- Mary Alice Farina
- Norma Moody Faulk
- Robert Taffy Faulk
- Christine Fensley
- FHPG, LLC
- FHPG, LLC
All providers in Southern Pines, NC · Obstetrics & Gynecology Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.