Individual provider Active NPI

Farra Martin Wilson, D.O.

  • Gastroenterology Physician
  • Pinehurst, NC
National Provider Identifier
1659667210
Registry record updated May 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
2013-02101 Issued in NC
Practice address
15 Regional Dr
Pinehurst, NC 28374-8850
Phone
(910) 295-5511
NPI assigned
Jun 22, 2011
Last updated
May 2, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 173003 NC
Gastroenterology Physician 207RG0100X 2013-02101 NC Primary

Addresses

Primary practice location

15 Regional Dr
Pinehurst, NC 28374-8850

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-3182

Other practice location 1

15 Regional Dr
Pinehurst, NC 28374-8850
Phone (910) 295-5511

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140827000860 NC Practitioner - GastroenterologyPractitioner - Internal Medicine 4082832498 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Kansas City College of Medicine and Surgery, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinehurst Medical Clinic IncGroup PAC ID 5991617169, shared by 3 NPIs, 162 clinicians

Practice addresses (Care Compare)

15 Regional Dr
Pinehurst, NC 28374-8850
Phone (910) 295-5511

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy69
Upper gastrointestinal (GI) endoscopy for acid reflux126

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
173003NCMDInternal Medicine Physician
2013-02101NCMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pinehurst Medical Clinic, Inc. Internal Medicine CurrentSince Aug 1, 2018 Accepting new patients
Pinehurst Medical Clinic, Inc. CurrentSince Aug 1, 2018 Accepting new patients
Pinehurst Medical Clinic, Inc. Past Accepting new patients

Locations

15 Regional Dr
Pinehurst, NC 28374
Phone (910) 255-4400

205 Page Rd
Pinehurst, NC 28374
Phone (910) 295-9211

110 Dennis Dr
Sanford, NC 27330
Phone (919) 774-4511

Interoperability endpoints

  • Direct secure messaging: farrawilson@phmc.allscriptsdirect.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525219200000",
    "number": "1659667210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-3182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 REGIONAL DR",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748850",
            "telephone_number": "910-295-5511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 Regional Dr",
            "address_purpose": "LOCATION",
            "city": "Pinehurst",
            "state": "NC",
            "postal_code": "283748850",
            "country_code": "US",
            "telephone_number": "910-295-5511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "FARRA",
        "middle_name": "MARTIN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-22",
        "last_updated": "2018-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "173003",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NC",
            "license": "2013-02101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinehurst, NC

Sources for this page

Verify at the official NPI Registry.