NPIMap

Individual provider Active NPI

Pravinkumar Kantilal Patel, MD

  • Internal Medicine Physician
  • Fayetteville, NC
National Provider Identifier
1669449179
Registry record updated Jun 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
9501632 Issued in NC
Practice address
4140 Ferncreek Dr Ste 501
Ferncreek Primary Care, PC
Fayetteville, NC 28314-2568
Phone
(910) 491-3922
Fax
(910) 491-5350
NPI assigned
Mar 2, 2006
Last updated
Jun 15, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2016

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 9501632 NC Primary

Addresses

Primary practice location

4140 Ferncreek Dr Ste 501
Ferncreek Primary Care, PC
Fayetteville, NC 28314-2568

Mailing address

4140 Ferncreek Dr
Ferncreek Primary Care, PC
Fayetteville, NC 28314-2563
Phone (910) 491-3922

Other identifiers 2

IdentifierTypeStateIssuer
11199OtherBCBS
1669449179MedicaidNC

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
I20101215000192 NC Practitioner - Internal Medicine 3870675937 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Physical Therapy Associates LLCGroup PAC ID 7012989684, shared by 7 NPIs, 496 clinicians

Practice addresses (Care Compare)

1314 Medical Dr
Suite 102
Fayetteville, NC 28304-4421
Phone (910) 491-3922

721 Tilghman Dr
Suite 100
Dunn, NC 28334-6066
Phone (910) 892-5635

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ferncreek Primary Care, PC Internal Medicine CurrentSince Oct 31, 2015 Accepting new patients
Cape Center Internal Medicine, PA Internal Medicine Past Accepting new patients

Locations

1314 Medical Dr
Ste 102
Fayetteville, NC 28304
Phone (910) 323-2503

4140 Ferncreek Dr
Ste 501
Fayetteville, NC 28314
Phone (910) 491-3922

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIADAD/Endpoint/EIADAD
  • FHIR API: https://fhir4.healow.com/fhir/r4/HDBHBA

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465948800000",
    "number": "1669449179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4140 FERNCREEK DR",
            "address_2": "FERNCREEK PRIMARY CARE, PC",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283142563",
            "telephone_number": "910-491-3922",
            "fax_number": "910-491-5350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4140 FERNCREEK DR STE 501",
            "address_2": "FERNCREEK PRIMARY CARE, PC",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283142568",
            "telephone_number": "910-491-3922",
            "fax_number": "910-491-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "PRAVINKUMAR",
        "middle_name": "KANTILAL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2016-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9501632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "11199",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669449179",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.