Surf Pediatrics and Medicine PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2002-00943 Issued in NC

Legal business name

SURF PEDIATRICS AND MEDICINE PC

Practice address

5107 N Croatan Hwy Ste 101
Kitty Hawk, NC 27949-3989

Phone

(252) 255-5321

Fax

(252) 565-0534

NPI assigned

Nov 28, 2007

Last updated

Aug 5, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Christian Thor Lige, M.D.NPI 1740283142

Title

Pediatrician

Phone

(252) 449-5200

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 18

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.

• Christian Thor Lige, MD

  • Pediatrics Physician
  • Kill Devil Hills, NC
  • NPI 1740283142
  Medicare reassignment Care Compare group NPD Authorized official
• Katelyn Nicole Angelo, FNP

  • Family Nurse Practitioner
  • Kitty Hawk, NC
  • NPI 1568243715
  Medicare reassignment Care Compare group NPD
• Jordan Ferrell, FNP-C

  • Family Nurse Practitioner
  • Kitty Hawk, NC
  • NPI 1487345377
  Medicare reassignment Care Compare group NPD
• Tarra O Midgette, FNP

  • Family Nurse Practitioner
  • Kitty Hawk, NC
  • NPI 1568097418
  Medicare reassignment Care Compare group NPD
• Zoe C Sherman, PA-C, MHS

  • Physician Assistant
  • Kitty Hawk, NC
  • NPI 1730231267
  Medicare reassignment Care Compare group NPD
• Todd Alan Feltz, PA-C

  • Physician Assistant
  • Kitty Hawk, NC
  • NPI 1164484044
  Medicare reassignment Care Compare group
• Alyssa Gottschalk, PA

  • Physician Assistant
  • Kitty Hawk, NC
  • NPI 1043992548
  Medicare reassignment Care Compare group
• Christy Wild, PA-C

  • Physician Assistant
  • Suffolk, VA
  • NPI 1588810519

  NC

  Medicare reassignment Care Compare group
• Tami Jo Bruggeman, MSN, APRN, FNP-BC

  • Nurse Practitioner
  • Kernersville, NC
  • NPI 1073376984
  Medicare reassignment NPD
• Johnny Lee Farrow, M.D.

  • Family Medicine Physician
  • Manteo, NC
  • NPI 1891831038
  Medicare reassignment NPD
• Jennifer Needs Demartino Harrison, DO

  • Family Medicine Physician
  • Nags Head, NC
  • NPI 1265929681
  Medicare reassignment NPD
• Mary McVean, FNP

  • Nurse Practitioner
  • Kill Devil Hills, NC
  • NPI 1083722623
  Medicare reassignment NPD

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596585600000",
    "number": "1609058056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5107 N CROATAN HWY",
            "city": "KITTY HAWK",
            "state": "NC",
            "postal_code": "279493989",
            "telephone_number": "252-255-5321",
            "fax_number": "252-565-0534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5107 N CROATAN HWY STE 101",
            "city": "KITTY HAWK",
            "state": "NC",
            "postal_code": "279493989",
            "telephone_number": "252-255-5321",
            "fax_number": "252-565-0534"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5107 N Croatan Hwy Ste 202",
            "address_purpose": "LOCATION",
            "city": "Kitty Hawk",
            "state": "NC",
            "postal_code": "279493989",
            "country_code": "US",
            "telephone_number": "252-255-5321",
            "fax_number": "252-565-0534",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 S Croatan Hwy",
            "address_purpose": "LOCATION",
            "city": "Kill Devil Hills",
            "state": "NC",
            "postal_code": "279488895",
            "country_code": "US",
            "telephone_number": "252-449-5200",
            "fax_number": "252-565-0534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SURF PEDIATRICS AND MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A",
        "authorized_official_last_name": "LIGE",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_middle_name": "THOR",
        "authorized_official_title_or_position": "PEDIATRICIAN",
        "authorized_official_telephone_number": "252-449-5200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2002-00943",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NC",
            "license": "200200943",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-01994",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5916879",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret St. Lawrence, PT, DPT
• Alanna Hope Stallings, PTA
• David Stumph, PHARMD
• Kathryn Haley Sullivan, NC LMBT
• Sarah Summerton, FNP-BC
• Steve Taylor, LCMHCA, LCAS
• The Wellness Center of the Outer Banks Inc
• Jennifer Thiessen, FNP-C
• Alexander Thompson, DMD
• Katherine Sweeney Thompson

• Pediatrics Physician in Kitty Hawk, NC
• Providers in Kitty Hawk, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.