NPIMap

Organization Active NPI

Cape Fear Valley Health System Specialty Group, LLC

Doing business as Three Rivers Medical Center

  • Family Medicine Physician
  • Saint Pauls, NC
National Provider Identifier
1750616108
Registry record updated Nov 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC
Doing business as
Three Rivers Medical Center
Practice address
580 W McLean St
Saint Pauls, NC 28384-1421
Phone
(910) 615-3570
Fax
(910) 865-3503
NPI assigned
Oct 2, 2009
Last updated
Nov 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2023

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
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

580 W McLean St
Saint Pauls, NC 28384-1421

Mailing address

PO Box 40908
Fayetteville, NC 28309-0908
Phone (910) 615-6448

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidNC

Other names 1

  • Three Rivers Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100223000688 NC Part B Supplier - Clinic/Group Practice 2567506942 Receives reassigned benefits from 6 practitioners
3 other NPIs on this enrollment
Practice locations: Elizabethtown, NC; Saint Pauls, NC

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

580 W McLean St
Saint Pauls, NC 28384
Phone (910) 615-3570

Practitioners & affiliated clinicians

Practitioners 6

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": "1254441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701302400000",
    "number": "1750616108",
    "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": "910-615-6448",
            "fax_number": "910-615-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 W MCLEAN ST",
            "city": "SAINT PAULS",
            "state": "NC",
            "postal_code": "283841421",
            "telephone_number": "910-615-3570",
            "fax_number": "910-865-3503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-02",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Rivers Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Pauls, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; 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.