NPIMap

Organization Active NPI

Pelican Family Medicine, P.a.

  • Family Medicine Physician
  • Wilmington, NC
National Provider Identifier
1669480042
Registry record updated Feb 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
200101001 Issued in NC
Legal business name
PELICAN FAMILY MEDICINE, P.A.
Practice address
5429 Wrightsville Ave
Wilmington, NC 28403-6513
Phone
(910) 792-1001
Fax
(910) 792-1004
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2011

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

Authorized official

Name
Mark T Armitage, M.D.
Title
Owner/Physician
Phone
(910) 792-1001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 200101001 NC Primary

Addresses

Primary practice location

5429 Wrightsville Ave
Wilmington, NC 28403-6513

Mailing address

5429 Wrightsville Ave
Wilmington, NC 28403-6513
Phone (910) 792-1001

Other identifiers 1

IdentifierTypeStateIssuer
89130GRMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081119000282 NC Part B Supplier - Clinic/Group Practice 0941360010 Receives reassigned benefits from 10 practitioners
5 other NPIs on this enrollment
Practice locations: Wilmington, NC

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Pelican Family Medicinep2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4833 Carolina Beach Rd
Wilmington, NC 28412
Phone (910) 332-7900

4833 Carolina Beach Rd
Ste 105
Wilmington, NC 28412

5905 Carolina Beach Rd
Ste 8
Wilmington, NC 28412
Phone (404) 632-6409

5429 Wrightsville Ave
Wilmington, NC 28403
Phone (910) 332-5074

4833 Carolina Beach Rd
#105106
Wilmington, NC 28412

Ownership & related parties

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298419200000",
    "number": "1669480042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5429 WRIGHTSVILLE AVE",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036513",
            "telephone_number": "910-792-1001",
            "fax_number": "910-792-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5429 WRIGHTSVILLE AVE",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036513",
            "telephone_number": "910-792-1001",
            "fax_number": "910-792-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELICAN FAMILY MEDICINE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2011-02-23",
        "status": "A",
        "authorized_official_last_name": "ARMITAGE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "910-792-1001",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200101001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89130GR",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.