Individual provider Active NPI

Michael William Wasowicz, APRN

  • Family Nurse Practitioner
  • Elizabeth City, NC
National Provider Identifier
1922407063
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5011826 Issued in NC
Practice address
3815 Conlon Way
Elizabeth City, NC 27909
Phone
(252) 580-2002
NPI assigned
Aug 14, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5011826 NC Primary
Family Nurse Practitioner 363LF0000X AP7739 AZ

Addresses

Primary practice location

3815 Conlon Way
Elizabeth City, NC 27909

Mailing address

PO Box 2789
Kitty Hawk, NC 27949-2789
Phone (928) 231-1859

Other practice location 1

315 Greenville Blvd SE Ste 100
Greenville, NC 27858-5733
Phone (252) 917-5621

Other practice location 2

9340 East Redfield Road
Scottsdale, AZ 85260
Phone (410) 948-0373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD, TX, NC, VA5 enrollments
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 5

Enrollment IDStateProvider typePAC IDDetails
I20141106002021 DC Practitioner - Nurse Practitioner 9931320264 Reassigns benefits to 1 organization
I20150116000402 MD Practitioner - Nurse Practitioner 9931320264 Reassigns benefits to 1 organization
I20160405000420 TX Practitioner - Nurse Practitioner 9931320264 Reassigns benefits to 3 organizations
I20190731002201 NC Practitioner - Nurse Practitioner 9931320264 Reassigns benefits to 2 organizations
I20250425001290 VA Practitioner - Nurse Practitioner 9931320264 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Velocity Urgent Care LLCGroup PAC ID 7618234980, 84 clinicians
Winslow Indian Health Care Center IncGroup PAC ID 4284548991, 99 clinicians

Practice addresses (Care Compare)

1944 Centerville Tpke
Suite 100
Virginia Beach, VA 23464-6839
Phone (757) 362-9067

3815 Conlon Way
Elizabeth City, NC 27909-9999
Phone (252) 580-2002

500 N Indiana Ave
Winslow, AZ 86047-2169
Phone (928) 289-4646

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP7739AZMDFamily Nurse Practitioner
5011826NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dilkon Medical Center Current Accepting new patients
Winslow Indian Health Care Center, Inc CurrentSince Oct 7, 2024 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Oct 16, 2017 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Jan 12, 2016 Accepting new patients
Winslow Indian Health Care Center, Inc CurrentSince Oct 7, 2024 Accepting new patients
Velocity Urgent Care, LLC CurrentSince May 1, 2025 Accepting new patients
Velocity Urgent Care LLC CurrentSince May 1, 2025 Accepting new patients
DHHS IHS Phoenix Area Current Accepting new patients
DHHS IHS Phoenix Area CurrentSince Oct 16, 2017 Accepting new patients
Winslow Indian Health Care Center, Inc Current Accepting new patients
Fastmed P.C. CurrentSince Jan 15, 2024 Accepting new patients
Arizona Pulmonary Specialists LTD PastSince Jan 1, 1997 Accepting new patients
Fastmed Primary Care, P.C. Past Accepting new patients

Locations

12033 Agency Rd
Parker, AZ 85344
Phone (760) 572-4137

500 Indiana Ave
Winslow, AZ 86047

1501 N Williamson Ave
Winslow, AZ 86047
Phone (928) 289-4691

178 Highway 105 Ext
Ste 101
Boone, NC 28607
Phone (828) 265-7146

7010 NC Highway 751
Durham, NC 27707
Phone (919) 313-3900

3815 Conlon Way
Elizabeth City, NC 27909
Phone (252) 580-2002

315 Greenville Blvd SE
Ste 100
Greenville, NC 27858
Phone (252) 917-5621

1944 Centerville Tpke
Ste 100
Virginia Beach, VA 23464
Phone (757) 362-9067

4374 New Town Ave
Williamsburg, VA 23188
Phone (757) 772-6124

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71750

Organizations & group practices 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1407974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743033600000",
    "number": "1922407063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2789",
            "city": "KITTY HAWK",
            "state": "NC",
            "postal_code": "279492789",
            "telephone_number": "928-231-1859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 CONLON WAY",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "27909",
            "telephone_number": "252-580-2002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 Greenville Blvd SE Ste 100",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278585733",
            "country_code": "US",
            "telephone_number": "252-917-5621",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9340 East Redfield Road",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "85260",
            "country_code": "US",
            "telephone_number": "410-948-0373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WASOWICZ",
        "first_name": "MICHAEL",
        "middle_name": "WILLIAM",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-14",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5011826",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP7739",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth City, NC

Sources for this page

Verify at the official NPI Registry.