NPIMap

Organization Active NPI

Elitecare of Fayetteville PLLC

  • Primary Care Clinic/Center
  • Hope Mills, NC
National Provider Identifier
1508297003
Registry record updated Dec 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ELITECARE OF FAYETTEVILLE PLLC
Practice address
3622 N Main St
Hope Mills, NC 28348-1937
Phone
(910) 423-7771
Fax
(910) 423-4177
NPI assigned
Dec 9, 2013
Last updated
Dec 9, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2013

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

Authorized official

Name
Mr. Travis Sanders Ross, PANPI 1578520417
Title
Organizer/Member
Phone
(910) 551-8882

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
Primary Care Clinic/Center 261QP2300X NU Primary
Urgent Care Clinic/Center 261QU0200X NU

Addresses

Primary practice location

3622 N Main St
Hope Mills, NC 28348-1937

Mailing address

3622 N Main St
Hope Mills, NC 28348-1937
Phone (910) 423-7771

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140212001136 NC Part B Supplier - Clinic/Group Practice 0749419893 Receives reassigned benefits from 3 practitioners
Practice locations: Hope Mills, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386547200000",
    "number": "1508297003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3622 N MAIN ST",
            "city": "HOPE MILLS",
            "state": "NC",
            "postal_code": "283481937",
            "telephone_number": "910-423-7771",
            "fax_number": "910-423-4177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3622 N MAIN ST",
            "city": "HOPE MILLS",
            "state": "NC",
            "postal_code": "283481937",
            "telephone_number": "910-423-7771",
            "fax_number": "910-423-4177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITECARE OF FAYETTEVILLE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-09",
        "last_updated": "2013-12-09",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "SANDERS",
        "authorized_official_title_or_position": "ORGANIZER/MEMBER",
        "authorized_official_telephone_number": "910-551-8882",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hope Mills, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2013; 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.