NPIMap

Organization Active NPI

Wilmington Gastroenterology Associates,PA

  • Gastroenterology Physician
  • Wilmington, NC
National Provider Identifier
1922040419
Registry record updated Jun 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
WILMINGTON GASTROENTEROLOGY ASSOCIATES,PA
Practice address
5115 Oleander Dr
Wilmington, NC 28403-7018
Phone
(910) 362-1011
NPI assigned
Jun 11, 2006
Last updated
Jun 26, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2008

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

Authorized official

Name
Mr. Steven L Peterson, MBA
Title
Practice Administrator
Phone
(910) 362-1011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

5115 Oleander Dr
Wilmington, NC 28403-7018

Mailing address

5115 Oleander Dr
Wilmington, NC 28403-7018
Phone (910) 362-1011

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040206000443 NC Part B Supplier - Clinic/Group Practice 2163315672 Receives reassigned benefits from 33 practitioners
Practice locations: Southport, NC; Whiteville, NC; Wilmington, NC

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0981311Wilmington Gastroenterology Associates, PA5115 Oleander Drive, Wilmington, NC 28403ComplianceJul 23, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1922040419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5115 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284037018",
            "telephone_number": "910-362-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284037018",
            "telephone_number": "910-362-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON GASTROENTEROLOGY ASSOCIATES,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "910-362-1011",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.