NPIMap

Organization Active NPI

Village Pediatrics of Chapel Hill, PA

  • Pediatrics Physician
  • Chapel Hill, NC
National Provider Identifier
1578650735
Registry record updated Jun 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
200500670 Issued in NC
Legal business name
VILLAGE PEDIATRICS OF CHAPEL HILL, PA
Practice address
300 Market St Ste 112
Chapel Hill, NC 27516-4493
Phone
(919) 969-9611
Fax
(919) 969-9615
NPI assigned
Oct 9, 2006
Last updated
Jun 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2015

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

Authorized official

Name
Dr. Kim A Gush, M.D./P.H.D
Title
President
Phone
(919) 969-9611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 200500670 NC Primary

Addresses

Primary practice location

300 Market St Ste 112
Chapel Hill, NC 27516-4493

Mailing address

300 Market St Ste 112
Chapel Hill, NC 27516-4493
Phone (919) 969-9611

Other identifiers 2

IdentifierTypeStateIssuer
5903100MedicaidNC
017VKOtherNCBCBSNC GROUP NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210506001677 NC Part B Supplier - Mass Immunization (Roster Biller Only) 8729497573 Practice locations: Chapel Hill, NC

National Provider Directory

National Provider Directory

Locations

300 Market St
Ste 112
Chapel Hill, NC 27516
Phone (919) 632-8699

Practitioners & affiliated clinicians

Practitioners 11

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": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433289600000",
    "number": "1578650735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MARKET ST STE 112",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275164493",
            "telephone_number": "919-969-9611",
            "fax_number": "919-969-9615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MARKET ST STE 112",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275164493",
            "telephone_number": "919-969-9611",
            "fax_number": "919-969-9615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE PEDIATRICS OF CHAPEL HILL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2015-06-03",
        "status": "A",
        "authorized_official_last_name": "GUSH",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-969-9611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D./P.H.D"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "200500670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903100",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC GROUP NUMBER",
            "identifier": "017VK",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chapel Hill, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; 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.