NPIMap

Organization Active NPI

Kurt G Vernon MD PA

  • Gastroenterology Physician
  • Cary, NC
National Provider Identifier
1962620997
Registry record updated Oct 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
9501139 Issued in NC
Legal business name
KURT G VERNON MD PA
Practice address
3412 Birk Bluff CT
Cary, NC 27518
Phone
(910) 891-5808
NPI assigned
Apr 23, 2007
Last updated
Oct 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2019

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

Authorized official

Name
Dr. Kurt G Vernon, MDNPI 1871559930
Title
President
Phone
(910) 891-5808

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X 9501139 NC Primary

Addresses

Primary practice location

3412 Birk Bluff CT
Cary, NC 27518

Mailing address

3412 Birk Bluff CT
Cary, NC 27518-8224
Phone (910) 891-5808

Other identifiers 3

IdentifierTypeStateIssuer
8985016MedicaidNC
84580OtherNCMEDCOST
85016OtherNCBLUE CROSS BLUE SHEILD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071030000207 NC Part B Supplier - Clinic/Group Practice 2860433984 Receives reassigned benefits from 5 practitioners
Practice locations: Dunn, NC

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

904 W Broad St
Dunn, NC 28334
Phone (910) 891-1999

Practitioners & affiliated clinicians

Practitioners 6

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": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569974400000",
    "number": "1962620997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3412 BIRK BLUFF CT",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275188224",
            "telephone_number": "910-891-5808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3412 BIRK BLUFF CT",
            "city": "CARY",
            "state": "NC",
            "postal_code": "27518",
            "telephone_number": "910-891-5808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KURT G VERNON MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2019-10-02",
        "status": "A",
        "authorized_official_last_name": "VERNON",
        "authorized_official_first_name": "KURT",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-891-5808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NC",
            "license": "9501139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8985016",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "84580",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "85016",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cary, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2019; 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.