NPIMap

Organization Active NPI

Scotland Memorial Hospital, Inc

Doing business as Wagram Family Practice

  • Rural Health Clinic/Center
  • Wagram, NC
National Provider Identifier
1891789970
Registry record updated Aug 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SCOTLAND MEMORIAL HOSPITAL, INC
Doing business as
Wagram Family Practice
Practice address
24420 Marlboro St
Wagram, NC 28396-9600
Phone
(910) 369-3136
Fax
(910) 369-4756
NPI assigned
Sep 6, 2005
Last updated
Aug 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2022

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

Authorized official

Name
Lucien Stonge
Title
Cfo
Phone
(910) 291-7547

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

24420 Marlboro St
Wagram, NC 28396-9600

Mailing address

24420 Marlboro St
Wagram, NC 28396-9600
Phone (910) 369-3136

Other names 1

  • Wagram Family Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031105000382 NC Part B Supplier - Clinic/Group Practice 0648208504 Receives reassigned benefits from 492 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Laurinburg, NC; Wagram, NC; Pembroke, NC
O20210426002437 NC Part A Provider - Rural Health Clinic 0648208504 Practice locations: Wagram, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891789970. Details of each certification follow.

Rural health clinic certification: CCN 343475

Legal name
SCOTLAND MEMORIAL HOSPITAL, INC
Doing business as
WAGRAM FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 27, 2021
Last certification
Jul 27, 2021
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Nov 26, 1947 in NC
Enrollment address
24420 Marlboro St
Wagram, NC 28396-9600
Related CCNs
340008

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory

Locations

24220 Marlboro St
Wagram, NC 28396

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jessica B Scott Individual Corporate Director Oct 1, 2019
Ravonda Sue John Individual Corporate DirectorBoard of Trustee Oct 1, 2019
Gregory Clark Wood Individual Contracted Managing Employee Apr 1, 2009
Corporate OfficerCeo Apr 1, 2009
Matthew David Pracht Individual Corporate OfficerCfo VP of Finance Apr 1, 2009
Corporate DirectorCfo VP of Finance Apr 1, 2009
W-2 Managing EmployeeCfo VP of Finance Apr 1, 2009
David Harling Individual Corporate DirectorBoard of Trustee Jan 1, 2010
John a Ferguson Individual Corporate Director Oct 1, 2020
James Roy McCook Individual Corporate DirectorBoard of Trustee Oct 1, 2020
Bradley Williams Individual Corporate DirectorBoard of Trustee Jan 1, 2019
Kenneth Nichols Individual Corporate DirectorBoard of Trustee Jan 1, 2006
Hampton Howard Hubbard Individual Corporate DirectorBoard of Trustee Oct 1, 2020
Wilbur Gene Shytle Individual Corporate DirectorBoard of Trustee Jan 1, 2013
Kurt Jute Individual Corporate DirectorBoard of Trustee Oct 1, 2020
Scott B Andrews Individual Corporate Director Jan 1, 2018
Robert N Hinson Individual Corporate DirectorBoard of Trustee Jan 1, 2014
Rebecca Hughes Individual Corporate DirectorBoard of Trustee Jan 1, 2019
Ralph E Carter Individual Corporate DirectorBoard of Trustee Oct 1, 2020
Sybil J Bullard Individual Corporate Director Jan 1, 2019
Charlotte-Mecklenburg Hospital Authority Organization, Charlotte, NC Operational/Managerial Control Apr 1, 2009
Glenn Ray Harris Individual Corporate DirectorBoard of Trustee Jan 1, 2017

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Marlboro Family Practice and Urgent CareBennettsville, SC, CCN 423461 Rural health clinic Operational/Managerial Control Dec 1, 2015

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661904000000",
    "number": "1891789970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24420 MARLBORO ST",
            "city": "WAGRAM",
            "state": "NC",
            "postal_code": "283969600",
            "telephone_number": "910-369-3136",
            "fax_number": "910-369-4756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24420 MARLBORO ST",
            "city": "WAGRAM",
            "state": "NC",
            "postal_code": "283969600",
            "telephone_number": "910-369-3136",
            "fax_number": "910-369-4756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTLAND MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A",
        "authorized_official_last_name": "STONGE",
        "authorized_official_first_name": "LUCIEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "910-291-7547"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wagram Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wagram Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wagram, NC

Sources for this page

Verify at the official NPI Registry.