Samuel H Weatherford, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0010-05179 Issued in NC

Practice address

112 Medical Village Dr Ste F
Wallace, NC 28466-1665

Phone

(910) 285-0940

Fax

(910) 285-1825

NPI assigned

May 22, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wallace Urgent Care LLCGroup PAC ID 6709967912, 8 clinicians

Apogee Medical Group North CarolinaGroup PAC ID 7719162254, 78 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Onslow Memorial Hospital Hospital, Jacksonville, NC, CCN 340042

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Wallace Urgent Care LLC

  • Internal Medicine Physician
  • Wallace, NC
  • NPI 1841259025
  Medicare reassignment Care Compare group
• Apogee Medical Group North Carolina

  • Hospitalist Physician
  • Scottsdale, AZ
  • NPI 1043518228

  NC

  Medicare reassignment Care Compare group
• Brynn Marr Hospital Inc

  • Psychiatry Physician
  • Jacksonville, NC
  • NPI 1568225845
  Medicare reassignment NPD

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

• Onslow Memorial Hospital Inc

  • General Acute Care Hospital
  • Jacksonville, NC
  • NPI 1679535496
  Care Compare affiliation

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721952000000",
    "number": "1508075896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 MEDICAL VILLAGE DR STE F",
            "city": "WALLACE",
            "state": "NC",
            "postal_code": "284661665",
            "telephone_number": "910-285-0940",
            "fax_number": "910-285-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 MEDICAL VILLAGE DR STE F",
            "city": "WALLACE",
            "state": "NC",
            "postal_code": "284661665",
            "telephone_number": "910-285-0940",
            "fax_number": "910-285-1825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEATHERFORD",
        "first_name": "SAMUEL",
        "middle_name": "H",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-05179",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "656",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-05179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wallace Drug Co Inc
• Wallace Gardens Inc
• Wallace Opco, LLC
• Wallace Urgent Care LLC
• Charles Edward Walton II, PA
• Roxie C Wells, M.D.
• Tommy Williams Jr., INC
• Wilson Family Pharmacies Inc
• Wilson Family Pharmacies, Inc
• Kevin M Wilson, R.PH.

• Medical Physician Assistant in Wallace, NC
• Providers in Wallace, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.