Wilmington Primary Care, PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

19777 Issued in NC

Legal business name

WILMINGTON PRIMARY CARE, PA

Practice address

1990 S 16TH St
Wilmington, NC 28401-6647

Phone

(910) 762-7071

Fax

(910) 762-9658

NPI assigned

Apr 17, 2007

Organization subpart

No

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

Authorized official

Name

Fred H Van Nynatten, M.D.NPI 1811076714

Title

Owner

Phone

(910) 762-7071

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fred H Vannynatten, MD

  • Internal Medicine Physician
  • Wilmington, NC
  • NPI 1811076714
  Medicare reassignment Authorized official
• Sandra Elaine Weibley, PA-C

  • Medical Physician Assistant
  • Wilmington, NC
  • NPI 1881862316
  Medicare reassignment

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881819407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 S 16TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016647",
            "telephone_number": "910-762-7071",
            "fax_number": "910-762-9658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 S 16TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016647",
            "telephone_number": "910-762-7071",
            "fax_number": "910-762-9658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON PRIMARY CARE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VAN NYNATTEN",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-762-7071",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "19777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilmington Pathology Associates PA
• Wilmington Pathology Associates PA
• Wilmington Pathology Laboratory Inc
• Wilmington Physical Therapy Inc
• Wilmington Plastic Surgery Specialists, P.a.
• Wilmington Proactive Medicine, PA
• Wilmington Psychotherapy, PLLC
• Wilmington Smiles Gregory B. Garrett DDS
• Wilmington Speech Associates PC
• Wilmington Surgery Center, LP

• Internal Medicine Physician in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.