NPIMap

Organization Active NPI

Fayetteville Area Health Education Foundation Inc

Doing business as Southern Regional Area Health Education Center

  • Family Medicine Physician
  • Fayetteville, NC
National Provider Identifier
1811072812
Registry record updated Oct 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAYETTEVILLE AREA HEALTH EDUCATION FOUNDATION INC
Doing business as
Southern Regional Area Health Education Center
Practice address
1601 Owen Dr
Fayetteville, NC 28304-3425
Phone
(910) 678-0100
Fax
(910) 678-0115
NPI assigned
Oct 26, 2006
Last updated
Oct 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2019

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

Authorized official

Name
Dr. Sushma Surrinder Kapoor, MDNPI 1497804421
Title
President & Ceo
Phone
(910) 678-7230

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X
Family Medicine Physician 207Q00000X Primary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X
Infectious Disease Physician 207RI0200X
Pediatrics Physician 208000000X
Pediatric Cardiology Physician 2080P0202X
Pediatric Endocrinology Physician 2080P0205X
Psychiatry Physician 2084P0800X

Addresses

Primary practice location

1601 Owen Dr
Fayetteville, NC 28304-3425

Mailing address

1601 Owen Dr
Fayetteville, NC 28304-3425
Phone (910) 678-0100

Other identifiers 1

IdentifierTypeStateIssuer
8903078MedicaidNC

Other names 1

  • Southern Regional Area Health Education Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040507000079 NC Part B Supplier - Clinic/Group Practice 9830188770 Receives reassigned benefits from 52 practitioners
Practice locations: Rockingham, NC; Fayetteville, NC; Clinton, NC

National Provider Directory

National Provider Directory

Locations

360 County Complex Rd
Clinton, NC 28328
Phone (910) 592-1131

360 County Complex Rd
Ste 10
Clinton, NC 28328

112 E Washington St
Rockingham, NC 28379
Phone (910) 678-0103

Practitioners & affiliated clinicians

Practitioners 60

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 60

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571961600000",
    "number": "1811072812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043425",
            "telephone_number": "910-678-0100",
            "fax_number": "910-678-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043425",
            "telephone_number": "910-678-0100",
            "fax_number": "910-678-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE AREA HEALTH EDUCATION FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2019-10-25",
        "status": "A",
        "authorized_official_last_name": "KAPOOR",
        "authorized_official_first_name": "SUSHMA",
        "authorized_official_middle_name": "SURRINDER",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "910-678-7230",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8903078",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Regional Area Health Education Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern Regional Area Health Education Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; 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.