NPIMap

Individual provider Active NPI

Ram Mohan R Bongu, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Fayetteville, NC
National Provider Identifier
1760485080
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
200300007 Issued in NC
Practice address
101 Robeson St
Ste 202
Fayetteville, NC 28301-5520
Phone
(910) 609-1630
Fax
(910) 609-1636
NPI assigned
May 31, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 200300007 NC
Geriatric Medicine (Family Medicine) Physician 207QG0300X 200300007 NC Primary

Addresses

Primary practice location

101 Robeson St
Ste 202
Fayetteville, NC 28301-5520

Mailing address

PO Box 40908
Fayetteville, NC 28309-0908
Phone (910) 609-6448

Other practice location 1

1218 Walter Reed Rd
Fayetteville, NC 28304-4440
Phone (910) 615-3960

Other practice location 2

6387 Ramsey St Unit 210
Fayetteville, NC 28311-9442
Phone (910) 615-3920

Other practice location 3

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-5680

Other practice location 4

1463 Pamalee Dr
Fayetteville, NC 28303-3974
Phone (910) 482-3000

Other identifiers 1

IdentifierTypeStateIssuer
8913352MedicaidNC

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
I20060221000060 NC Practitioner - Geriatric MedicinePractitioner - Family Practice 0547275000 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Family Practice
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1218 Walter Reed Rd
Fayetteville, NC 28304-4440
Phone (910) 615-3960

1463 Pamalee Dr
Fayetteville, NC 28303-3974
Phone (910) 482-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200300007NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cape Fear Valley Health Medical Group LLC CurrentSince Oct 15, 2025 Accepting new patients
Cape Fear Valley Health Medical Group LLC CurrentSince Oct 15, 2025 Accepting new patients
Cape Fear Valley Health Medical Group LLC Current Accepting new patients
Cumberland County Hospital System Inc CurrentSince May 2, 2023 Accepting new patients
Cumberland County Hospital System Inc Current Accepting new patients

Locations

6387 Ramsey St
Unit 210
Fayetteville, NC 28311
Phone (910) 609-3920

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

4140 Ferncreek Dr
Ste 801
Fayetteville, NC 28314
Phone (910) 484-2171

1218 Walter Reed Rd
Fayetteville, NC 28304
Phone (910) 323-1671

Interoperability endpoints

  • Direct secure messaging: rbongu81947@capefearvalley.direct-ci.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1760485080",
    "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": "910-609-6448",
            "fax_number": "910-609-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 ROBESON ST",
            "address_2": "STE 202",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015520",
            "telephone_number": "910-609-1630",
            "fax_number": "910-609-1636"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1218 Walter Reed Rd",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283044440",
            "country_code": "US",
            "telephone_number": "910-615-3960",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6387 Ramsey St Unit 210",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283119442",
            "country_code": "US",
            "telephone_number": "910-615-3920",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1638 Owen Dr",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043424",
            "country_code": "US",
            "telephone_number": "910-615-5680",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1463 Pamalee Dr",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283033974",
            "country_code": "US",
            "telephone_number": "910-482-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONGU",
        "first_name": "RAM MOHAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-31",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200300007",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NC",
            "license": "200300007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8913352",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.