Peter Allen Fenn, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

100867 Issued in NC

Practice address

129 Lanier St.
Buies Creek, NC 27506-0565

Phone

(910) 893-1559

Fax

(910) 893-1559

NPI assigned

May 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Wake Forest University School of Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifelink Medical Group PLLCGroup PAC ID 0446576375, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centerwell Home Health Home health agency, Lillington, NC, CCN 347089
• Betsy Johnson Regional Hospital Hospital, Dunn, NC, CCN 340071

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: peter.fenn.2@22709.direct.athenahealth.com

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.

• Lifelink Medical Group PLLC

  • Family Medicine Physician
  • Erwin, NC
  • NPI 1093104929
  Medicare reassignment Care Compare group
• Allmed Clinic PA

  • Internal Medicine Physician
  • Raleigh, NC
  • NPI 1346534419
  Medicare reassignment
• Rex Hospital Inc

  • Cardiovascular Disease Physician
  • Raleigh, NC
  • NPI 1972939643
  NPD (past)

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

• Harnett Health System, Inc.

  • General Acute Care Hospital
  • Dunn, NC
  • NPI 1922144757
  Care Compare affiliation
• Kah Development 12, LLC

  • Home Health Agency
  • Lillington, NC
  • NPI 1689119349
  Care Compare affiliation

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586736000000",
    "number": "1831140268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 COUNTRY MEADOW LN.",
            "city": "COATS",
            "state": "NC",
            "postal_code": "275219556",
            "telephone_number": "910-897-2354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 LANIER ST.",
            "city": "BUIES CREEK",
            "state": "NC",
            "postal_code": "275060565",
            "telephone_number": "910-893-1559",
            "fax_number": "910-893-1559"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3050 Duraleigh Rd Ste 111",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276125451",
            "country_code": "US",
            "telephone_number": "984-215-6990",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4420 Lake Boone Trl",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276077505",
            "country_code": "US",
            "telephone_number": "919-784-3100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FENN",
        "first_name": "PETER",
        "middle_name": "ALLEN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "100867",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "100867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carenet, Inc.
• Alyssa J. Carlin
• Brandon Casanova
• Brishen Dearborn, ATC
• Michelle Tabler Dietrich, R.N.
• Shelia Glenn, RN
• Abigail R Harrison, MS, LAT, ATC
• Alissa Hennen
• Angela C. Holland, R.N.
• Betty Lynne Johnson, PA-C

• Physician Assistant in Buies Creek, NC
• Providers in Buies Creek, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.