NPIMap

Individual provider Active NPI

Walter S Fasolak, DO

  • Obstetrics & Gynecology Physician
  • Southern Pines, NC
National Provider Identifier
1497716211
Registry record updated Feb 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
39728 Issued in 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
Last updated
Feb 25, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 39728 NC Primary

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

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
I20100430000706 NC Practitioner - Obstetrics/Gynecology 1759339757 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
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 LLCGroup PAC ID 7416198890, 32 clinicians

Practice addresses (Care Compare)

145 Applecross Rd
Pinehurst, NC 28374-8521
Phone (910) 692-7928

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.49 of 100Reported as group
Quality
98.47
Promoting interoperability
81
Improvement activities
40
Cost
88.99

Merit-based Incentive Payment System (MIPS)

Final score
93.61 of 100Reported as group
Quality
93.9
Promoting interoperability
91
Improvement activities
40
Cost
85.33

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39728NCMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCPC-12, LLC CurrentSince Jul 1, 2013 Accepting new patients
MCPC-12, LLC Obstetrics & Gynecology CurrentSince Jul 1, 2013 Accepting new patients
MCPC-7, LLC CurrentSince Feb 1, 2023 Accepting new patients
FHPG, LLC Past Accepting new patients
FHPG, LLC PastSince Mar 27, 2006 Accepting new patients

Locations

104 Rice St
Hamlet, NC 28345
Phone (910) 582-4003

46 Memorial Dr
Pinehurst, NC 28374
Phone (910) 295-6782

5 First Village Dr
Ste 100
Pinehurst, NC 28374
Phone (910) 692-7928

313 Teal Dr
Raeford, NC 28376
Phone (910) 904-2350

110 Medical Cir
Rockingham, NC 28379
Phone (910) 410-9494

Interoperability endpoints

  • Direct secure messaging: wfasolak@spwhc.gwaydirect.com

Ownership & related parties

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Firsthealth Montgomery Memorial HospitalTroy, NC, CCN 341303 Hospital Corporate Director
Operational/Managerial Control		 Dec 7, 2004
Sep 18, 2012
Firsthealth Moore Regional Hospital RehabPinehurst, NC, CCN 34T115 Hospital Corporate Director
Operational/Managerial Control		 Nov 17, 2011
Nov 17, 2011
Firsthealth Montgomery Memorial HospitalTroy, NC, CCN 34Z303 Skilled nursing facility Corporate Director
Operational/Managerial Control		 Nov 14, 2011
Nov 14, 2011
First Health Home CareWest End, NC, CCN 347230 Home health agency Corporate Director Sep 15, 2010
First Health Home Care - RichmondRockingham, NC, CCN 347041 Home health agency Corporate Director Aug 10, 2010
Firsthealth Hospice and Palliative CareWest End, NC, CCN 341534 Hospice Corporate Director Oct 9, 2002
Firsthealth Montgomery Memorial HospitalTroy, NC, CCN 343431 Rural health clinic Corporate Director Sep 1, 2008

Owned or controlled facilities with NPI records 7

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

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

  • MCPC-12, LLC

    dba FirstHealth Southern Pines Women's Health Center

    • Gynecology Physician
    • Pinehurst, NC
    • NPI 1306283080

    Obstetrics & Gynecology

    Medicare reassignment Care Compare group NPD
  • MCPC-7, LLC

    dba Sandhills Regional Physician Group

    • Internal Medicine Physician
    • Hamlet, NC
    • NPI 1881968709
    Medicare reassignment NPD
  • MCPC-12, LLC

    dba FirstHealth Urogynecology

    • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
    • Pinehurst, NC
    • NPI 1003650391
    NPD
  • FHPG, LLC

    dba FirstHealth Moore Regional Hospital Professional Services

    • Specialist
    • Pinehurst, NC
    • NPI 1770512865
    NPD (past)
  • FHPG, LLC

    dba FirstHealth Primary Care-Whispering Pines

    • Family Medicine Physician
    • Whispering Pines, NC
    • NPI 1851710388
    NPD (past)

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267056000000",
    "number": "1497716211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749",
            "address_2": "SOUTHERN PINES WOMENS HEALTH CENTER PC",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283880749",
            "telephone_number": "910-692-7928",
            "fax_number": "910-692-5962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 APPLECROSS RD",
            "address_2": "SOUTHERN PINES WOMENS HEALTH CENTER PC",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "28387",
            "telephone_number": "910-692-7928",
            "fax_number": "910-692-5962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASOLAK",
        "first_name": "WALTER",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2010-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "39728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southern Pines, NC

Sources for this page

Verify at the official NPI Registry.