NPIMap

Individual provider Active NPI

Camille F Elliott, FNP-C

  • Nurse Practitioner
  • Fayetteville, NC
National Provider Identifier
1639983380
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5021652 Issued in NC
Practice address
906 Bingham Dr
Fayetteville, NC 28304-2842
Phone
(910) 965-5498
NPI assigned
Feb 4, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 26NJ15185400 NJ
Nurse Practitioner 363L00000X SP031805 PA
Nurse Practitioner 363L00000X 5021652 NC Primary

Addresses

Primary practice location

906 Bingham Dr
Fayetteville, NC 28304-2842

Mailing address

PO Box 746724
Atlanta, GA 30374-6724

Other practice location 1

103 Country Club Dr
Fayetteville, NC 28301-7603
Phone (910) 719-9314

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250228003467 NC Practitioner - Nurse Practitioner 5890216204 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osh Mi Physicians Group, PCGroup PAC ID 7810282191, 154 clinicians

Practice addresses (Care Compare)

906 Bingham Dr
Fayetteville, NC 28304-2842
Phone (910) 213-3547

Hospital & facility affiliations

  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ15185400NJMDNurse Practitioner
SP031805PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Osh Mi Physicians Group, PC CurrentSince Mar 17, 2025 Accepting new patients
Osh-Mi Physicians Group PC CurrentSince Mar 17, 2025 Accepting new patients

Locations

3250 Freedom Dr
Charlotte, NC 28208
Phone (704) 394-0118

103 Country Club Dr
Fayetteville, NC 28301
Phone (910) 400-7002

906 Bingham Dr
Fayetteville, NC 28304
Phone (910) 213-3547

Organizations & group practices 2

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1738627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1639983380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746724",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 BINGHAM DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283042842",
            "telephone_number": "910-965-5498"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "103 Country Club Dr",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283017603",
            "country_code": "US",
            "telephone_number": "910-719-9314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "CAMILLE",
        "middle_name": "F",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-04",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ15185400",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP031805",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5021652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.