NPIMap

Organization Active NPI

Lower Cape Fear Hospice, Incorporated

Doing business as Lower Cape Fear LifeCare

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Wilmington, NC
National Provider Identifier
1790258234
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
LOWER CAPE FEAR HOSPICE, INCORPORATED
Doing business as
Lower Cape Fear LifeCare
Practice address
1414 Physicians Dr
Wilmington, NC 28401-7335
Phone
(910) 796-7900
Fax
(910) 796-7901
NPI assigned
Jan 8, 2019
Last updated
Dec 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Authorized official

Name
Gwen Whitley
Title
President/Ceo
Phone
(910) 796-7900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X Primary

Addresses

Primary practice location

1414 Physicians Dr
Wilmington, NC 28401-7335

Mailing address

1414 Physicians Dr
Wilmington, NC 28401-7335
Phone (910) 796-7900

Other identifiers 1

IdentifierTypeStateIssuer
89012N8MedicaidNC

Other names 1

  • Lower Cape Fear LifeCare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040122000909 NC Part B Supplier - Clinic/Group Practice 3375445190 Receives reassigned benefits from 41 practitioners
2 other NPIs on this enrollment
Practice locations: Wilmington, NC

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

16747 US Highway 17
Ste 106
Hampstead, NC 28443
Phone (910) 300-9032

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lower Cape Fear LifecareWilmington, NC, CCN 341515 Hospice Operational/Managerial Control Nov 28, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 42

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.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1790258234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 PHYSICIANS DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017335",
            "telephone_number": "910-796-7900",
            "fax_number": "910-796-7901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 PHYSICIANS DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017335",
            "telephone_number": "910-796-7900",
            "fax_number": "910-796-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOWER CAPE FEAR HOSPICE, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-08",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "WHITLEY",
        "authorized_official_first_name": "GWEN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "910-796-7900"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89012N8",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lower Cape Fear LifeCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.