Individual provider Active NPI

Nwaobiara Obi-Gwacham, MD

  • Internal Medicine Physician
  • Fayetteville, NC
National Provider Identifier
1619971587
Registry record updated Jul 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
200300856 Issued in NC
Practice address
2300 Ramsey St
Fayetteville, NC 28301-3856
Phone
(910) 488-2120
NPI assigned
Jun 9, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 200300856 NC Primary

Addresses

Primary practice location

2300 Ramsey St
Fayetteville, NC 28301-3856

Mailing address

PO Box 40908
Fayetteville, NC 28309-0908
Phone (910) 615-6448

Other identifiers 1

IdentifierTypeStateIssuer
89134NVMedicaidNC

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051011000842 NC Practitioner - Hospitalist 4880619618 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
200300856NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cumberland County Hospital System Inc CurrentSince Jul 14, 2003 Accepting new patients
Cumberland County Hospital System Inc Current Accepting new patients
Cumberland County Hospital System Inc Internal Medicine CurrentSince Jul 14, 2003 Accepting new patients
Robeson Hospitalist Group PLLC CurrentSince Jan 1, 2020 Accepting new patients

Locations

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

300 W 27th St
Lumberton, NC 28358
Phone (910) 671-5000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564099200000",
    "number": "1619971587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40908",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283090908",
            "telephone_number": "910-615-6448",
            "fax_number": "910-615-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 RAMSEY ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283013856",
            "telephone_number": "910-488-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBI-GWACHAM",
        "first_name": "NWAOBIARA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2019-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "200300856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89134NV",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.