NPIMap

Organization Active NPI

Scotland Memorial Hospital Inc

Doing business as Pembroke Family Practice Center

  • Rural Health Clinic/Center
  • Pembroke, NC
National Provider Identifier
1508850447
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SCOTLAND MEMORIAL HOSPITAL INC
Doing business as
Pembroke Family Practice Center
Pembroke Family Practice and Urgent Care
Practice address
412 S. Jones St.
Pembroke, NC 28372
Phone
(910) 521-4462
Fax
(910) 521-7739
NPI assigned
Sep 7, 2005
Last updated
Sep 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Authorized official

Name
Lucien Stonge
Title
Cfo
Phone
(910) 291-7547

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NC Primary

Addresses

Primary practice location

412 S. Jones St.
Pembroke, NC 28372

Mailing address

PO Box 604093
Charlotte, NC 28260-4093
Phone (910) 291-7000

Other names 2

  • PEMBROKE FAMILY PRACTICE CENTER Doing business as
  • Pembroke Family Practice and Urgent Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030627000007 NC Part A Provider - Rural Health Clinic 0648208504 Practice locations: Pembroke, NC
O20031105000382 NC Part B Supplier - Clinic/Group Practice 0648208504 Receives reassigned benefits from 492 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Laurinburg, NC; Wagram, NC; Pembroke, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508850447. Details of each certification follow.

Rural health clinic certification: CCN 343982

Legal name
SCOTLAND MEMORIAL HOSPITAL, INC
Doing business as
PEMBROKE FAMILY PRACTICE & URGENT CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 15, 1989
Last certification
Feb 24, 2021
Ownership / control type
2B
Organization structure
CorporationProprietary
Incorporated
Mar 15, 1989 in NC
Enrollment address
412 S Jones St
Pembroke, NC 28372-7261
Related CCNs
340008

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0245413Pembroke Family Practice & Urgent Care412 S Jones Street, Pembroke, NC 28372Provider-performed microscopyFeb 5, 2027

National Provider Directory

National Provider Directory

Locations

700 Progress Pl
#A
Laurinburg, NC 28352
Phone (910) 276-6767

Ownership & related parties

All disclosed owners & managing parties 21

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jessica B Scott Individual Corporate DirectorBoard of Trustee Oct 1, 2019
Ravonda Sue John Individual Corporate DirectorBoard of Trustee Oct 1, 2019
Gregory Clark Wood Individual Corporate DirectorPresident, Ceo Jun 27, 2003
Matthew David Pracht Individual Corporate DirectorVP, Cfo Jan 1, 1992
Mark a Hansman Individual Corporate DirectorBoard of Trustee, Chief of Staff Jan 1, 2018
Christopher M Ward Individual Corporate OfficerBoard of Trustees Jan 1, 2019
David Harling Individual Corporate Director Jan 1, 2010
Jane Rogers Individual Corporate DirectorBoard of Trustee Jan 1, 2012
Bradley Williams Individual Corporate DirectorBoard of Trustee Jan 1, 2019
Kenneth Nichols Individual Corporate Director Jan 1, 2006
Douglas Frank Nederostek Individual Corporate DirectorBoard of Trustee Oct 1, 2019
Ruth Bland Individual W-2 Managing Employee Apr 1, 2008
Other Apr 1, 2008
Wilbur Gene Shytle Individual Corporate OfficerBoard of Trustees Jan 1, 2013
Scotland Health Care System Organization, Laurinburg, NC 5% Or Greater Direct Ownership Interest Nov 30, 1994
John Ray Nobles Individual Corporate Director Jan 1, 2016
Scott B Andrews Individual Corporate DirectorBoard of Trustee Jan 1, 2018
Robert N Hinson Individual Corporate DirectorBoard of Trustee Jan 1, 2014
Rebecca Hughes Individual Corporate DirectorBoard of Trustee Dec 1, 2018
Sybil J Bullard Individual Corporate DirectorBoard of Trustee Dec 1, 2018
Charlotte-Mecklenburg Hospital Authority Organization, Charlotte, NC Operational/Managerial Control Apr 1, 2009
Glenn Ray Harris Individual Corporate DirectorBoard of Trustee Jan 1, 2017

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Marlboro Family Practice and Urgent CareBennettsville, SC, CCN 423461 Rural health clinic Operational/Managerial Control Dec 1, 2015

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 5

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": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1508850447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604093",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282604093",
            "telephone_number": "910-291-7000",
            "fax_number": "910-521-7739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 S. JONES ST.",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "28372",
            "telephone_number": "910-521-4462",
            "fax_number": "910-521-7739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTLAND MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-07",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "STONGE",
        "authorized_official_first_name": "LUCIEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "910-291-7547"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEMBROKE FAMILY PRACTICE CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PEMBROKE FAMILY PRACTICE CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pembroke Family Practice and Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pembroke, NC

Sources for this page

Verify at the official NPI Registry.