NPIMap

Organization Active NPI

Bladen Healthcare, LLC

Doing business as Cape Fear Valley - Bladen Surgical Specialists

  • Surgery Physician
  • Elizabethtown, NC
National Provider Identifier
1700052289
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
BLADEN HEALTHCARE, LLC
Doing business as
Cape Fear Valley - Bladen Surgical Specialists
Practice address
300A E McKay St
Elizabethtown, NC 28337-9037
Phone
(910) 862-1272
Fax
(910) 862-2107
NPI assigned
May 5, 2008
Last updated
May 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Authorized official

Name
Joseph B Fiser
Title
VP Managed Care and Revenue Cycle
Phone
(910) 615-5572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

300A E McKay St
Elizabethtown, NC 28337-9037

Mailing address

PO Box 40908
Fayetteville, NC 28309-0908
Phone (910) 615-6949

Other practice location 1

588 Bailey Rd Ste K
Lumberton, NC 28358-2470
Phone (910) 862-1272

Other names 1

  • Cape Fear Valley - Bladen Surgical Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080617000314 NC Part B Supplier - Clinic/Group Practice 6800967969 Receives reassigned benefits from 173 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elizabethtown, NC; Whiteville, NC; Lumberton, NC; Dublin, NC; Clarkton, NC; Bladenboro, NC

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Bladen Healthcare LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1209945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1700052289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40908",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283090908",
            "telephone_number": "910-615-6949",
            "fax_number": "910-615-9761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300A E MCKAY ST",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283379037",
            "telephone_number": "910-862-1272",
            "fax_number": "910-862-2107"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "588 Bailey Rd Ste K",
            "address_purpose": "LOCATION",
            "city": "Lumberton",
            "state": "NC",
            "postal_code": "283582470",
            "country_code": "US",
            "telephone_number": "910-862-1272",
            "fax_number": "910-862-2107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLADEN HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-05",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "FISER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "VP MANAGED CARE AND REVENUE CYCLE",
        "authorized_official_telephone_number": "910-615-5572"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cape Fear Valley - Bladen Surgical Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cape Fear Valley - Bladen Surgical Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elizabethtown, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; 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.