Active NPI
Pinehurst Surgical Clinic, PA
Doing business as Pinehurst Surgical Clinic
- Surgery Physician
- Fayetteville, NC
National Provider Identifier
1710609276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- PINEHURST SURGICAL CLINIC, PA
- Doing business as
- Pinehurst Surgical Clinic
- Practice address
- 3716 Morganton Rd
Fayetteville, NC 28303-4963 - Phone
- (910) 302-8026
- Fax
- (910) 420-1988
- NPI assigned
- Sep 13, 2022
- Last updated
- Sep 13, 2022
- Organization subpart
- Yes
- Parent organization
- PINEHURST SURGICAL CLINIC PA
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Katie Richardson Heffner
- Title
- Credentialing Coordinator
- Phone
- (910) 235-2711
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | NU | Primary |
Addresses
Primary practice location
3716 Morganton Rd
Fayetteville, NC 28303-4963
Mailing address
PO Box 2000
Pinehurst, NC 28374-2000
Phone (910) 295-6831
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 890297E | Medicaid | NC |
Other names 1
- Pinehurst Surgical Clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240709004786 | NC | DME Supplier - Multi-Specialty - Physician | 4587561394 | Practice locations: Southern Pines, NC |
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Part of
- Pinehurst Surgical Clin
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Surgery Physician
- Pinehurst, NC
- NPI 1962434324
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663027200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1663027200000",
"number": "1710609276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2000",
"city": "PINEHURST",
"state": "NC",
"postal_code": "283742000",
"telephone_number": "910-295-6831",
"fax_number": "910-295-0244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3716 MORGANTON RD",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283034963",
"telephone_number": "910-302-8026",
"fax_number": "910-420-1988"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PINEHURST SURGICAL CLINIC, PA",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PINEHURST SURGICAL CLINIC PA",
"enumeration_date": "2022-09-13",
"last_updated": "2022-09-13",
"certification_date": "2022-09-13",
"status": "A",
"authorized_official_last_name": "HEFFNER",
"authorized_official_first_name": "KATIE",
"authorized_official_middle_name": "RICHARDSON",
"authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
"authorized_official_telephone_number": "910-235-2711"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "890297E",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Pinehurst Surgical Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fayetteville, NC
- Nathaniel Pinckney
- Pine Valley Adult Care Home
- Pine Village Treatment Services
- Pine Village Treatment Services, Inc.
- Pineapple Express Transportation LLC
- Imani Pinkney
- Pinnacle Family Care PLLC
- Pinnacle Family Services of North Carolina LLC
- Pinnacle Healthcare Services Inc
- Eduardo De Jesus Pino Domenech, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; 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.