Active NPI
Pinehurst Surgical Clinic PA
- Surgery Physician
- Sanford, NC
National Provider Identifier
1851572218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- PINEHURST SURGICAL CLINIC PA
- Practice address
- 1818 Doctors Dr
Sanford, NC 27330-5057 - Phone
- (919) 895-6340
- NPI assigned
- Nov 14, 2007
- Last updated
- Jul 21, 2020
- Organization subpart
- Yes
- Parent organization
- PINEHURST SURGICAL CLINIC PA
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Charles Gregg, CEO
- Title
- Chief Executive Officer
- Phone
- (910) 295-6831
Specialties & licenses 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | NU | ||
| Obstetrics & Gynecology Physician | 207V00000X | NU | ||
| Orthopaedic Surgery Physician | 207X00000X | NU | ||
| Otolaryngology Physician | 207Y00000X | NU | ||
| Physical Medicine & Rehabilitation Physician | 208100000X | NU | ||
| Surgery Physician | 208600000X | NU | Primary | |
| Vascular Surgery Physician | 2086S0129X | NU | ||
| Urology Physician | 208800000X | NU |
Addresses
Primary practice location
1818 Doctors Dr
Sanford, NC 27330-5057
Mailing address
PO Box 2000
Pinehurst, NC 28374-2000
Phone (910) 295-6831
Other practice location 1
709 Wicker St
Sanford, NC 27330-4142
Phone (919) 776-0465
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031218000239 | NC | Part B Supplier - Clinic/Group Practice | 4587561394 |
Receives reassigned benefits from 132 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fayetteville, NC; Pinehurst, NC; Raeford, NC; Rockingham, NC; Sanford, NC; Southern Pines, NC; Troy, NC |
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Pinehurst Surgical Clinic PA
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Surgery Physician
- Pinehurst, NC
- NPI 1962434324
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194998400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1595289600000",
"number": "1851572218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2000",
"city": "PINEHURST",
"state": "NC",
"postal_code": "283742000",
"telephone_number": "910-295-6831",
"fax_number": "910-295-0244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1818 DOCTORS DR",
"city": "SANFORD",
"state": "NC",
"postal_code": "273305057",
"telephone_number": "919-895-6340"
}
],
"practiceLocations": [
{
"address_1": "709 Wicker St",
"address_purpose": "LOCATION",
"city": "Sanford",
"state": "NC",
"postal_code": "273304142",
"country_code": "US",
"telephone_number": "919-776-0465",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "PINEHURST SURGICAL CLINIC PA",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PINEHURST SURGICAL CLINIC PA",
"enumeration_date": "2007-11-14",
"last_updated": "2020-07-21",
"certification_date": "2020-07-21",
"status": "A",
"authorized_official_last_name": "GREGG",
"authorized_official_first_name": "CHARLES",
"authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "910-295-6831",
"authorized_official_credential": "CEO"
},
"taxonomies": [
{
"code": "207T00000X",
"taxonomy_group": "",
"desc": "Neurological Surgery",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sanford, NC
- Rachel Elizabeth Piening, PA-C
- Amanda Pilkington, PHARMD
- Pine Ridge of Sanford Primary Care PLLC
- Pine Ridge Urgent Care and Occupational Medicine Center PLLC
- Pinehurst Surgical Clinic PA
- Pinnacle Family Services of North Carolina LLC
- Murali Dhara Pisharody, MD
- Tracy Lynn Poe, LCMHC
- Saurav Pokharel, MD
- Jamal Porter Jr., NP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; 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.