NPIMap

Organization Active NPI

Pinehurst Medical Clinic, Inc.

Doing business as PMC Reference Lab

  • Clinical Medical Laboratory
  • Southern Pines, NC
National Provider Identifier
1962509372
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
39578 Issued in NC
Legal business name
PINEHURST MEDICAL CLINIC, INC.
Doing business as
PMC Reference Lab
Practice address
200 Pavilion Way
Southern Pines, NC 28387-4561
Phone
(910) 639-9088
NPI assigned
Sep 20, 2006
Last updated
Sep 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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

Authorized official

Name
Brandon Enfinger
Title
Ceo
Phone
(910) 235-3004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 39578 NC Primary

Addresses

Primary practice location

200 Pavilion Way
Southern Pines, NC 28387-4561

Mailing address

205 Page Rd
Pinehurst, NC 28374-8798
Phone (910) 295-5511

Other practice location 1

205 Page Rd
Pinehurst, NC 28374-8798
Phone (910) 295-5511

Other identifiers 4

IdentifierTypeStateIssuer
02418OtherBC/BS NC
FH6600055OtherFIRSTCAROLINACARE
690003763OtherPALMETTO GBA (R/R MCR)
7001306MedicaidNC

Other names 1

  • PMC Reference Lab Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050207000855 NC Part B Supplier - Independent Clinical Laboratory 5991617169 Practice locations: Pinehurst, NC

Other NPIs with the same Medicare PAC ID 2

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
34D0655405Pinehurst Medical Clinic, Inc205 Page Road, Pinehurst, NC 28374AccreditationDec 8, 2026
34D2015299Pinehurst Medical Clinic205 Page Road, Pinehurst, NC 28374AccreditationJan 29, 2027
34D2256927Pinehurst Medical Clinic at Morganton200 Pavilion Way, Southern Pines, NC 28387Certificate of waiverMar 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
PMC Laboratory4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 344

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 344

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663027200000",
    "number": "1962509372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 PAGE RD",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748798",
            "telephone_number": "910-295-5511",
            "fax_number": "910-235-3443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PAVILION WAY",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283874561",
            "telephone_number": "910-639-9088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 Page Rd",
            "address_purpose": "LOCATION",
            "city": "Pinehurst",
            "state": "NC",
            "postal_code": "283748798",
            "country_code": "US",
            "telephone_number": "910-295-5511",
            "fax_number": "910-235-3443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PINEHURST MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2022-09-13",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "ENFINGER",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-235-3004"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NC",
            "license": "39578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS NC",
            "identifier": "02418",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCAROLINACARE",
            "identifier": "FH6600055",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA (R/R MCR)",
            "identifier": "690003763",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7001306",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PMC Reference Lab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PMC Reference Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southern Pines, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; 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.