Active NPI
Subbarao Venkata Pemmaraju, M.D.
- Geriatric Medicine (Family Medicine) Physician
- Fayetteville, NC
National Provider Identifier
1639130008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Family Medicine) Physician
- Practice address
- 2300 Ramsey St
Vamc, Division of LTC/Geriatrics, 11G
Fayetteville, NC 28301-3856 - Phone
- (910) 488-2120
- NPI assigned
- Mar 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | IL | Primary |
Addresses
Primary practice location
2300 Ramsey St
Vamc, Division of LTC/Geriatrics, 11G
Fayetteville, NC 28301-3856
Mailing address
2938 Lambrusco PL
Fayetteville, NC 28306-9282
Phone (910) 868-3717
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: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140624000586 | NC | Order and Referring Only - Family Practice | 4688898117 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1639130008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2938 LAMBRUSCO PL",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283069282",
"telephone_number": "910-868-3717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 RAMSEY ST",
"address_2": "VAMC, DIVISION OF LTC/GERIATRICS, 11G",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283013856",
"telephone_number": "910-488-2120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEMMARAJU",
"first_name": "SUBBARAO",
"middle_name": "VENKATA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-28",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.