Fayetteville Gastroenterology Endoscopy Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER, LLC

Practice address

2041 Valleygate Dr
Fayetteville, NC 28304-3745

Phone

(910) 323-5203

Fax

(910) 323-3650

NPI assigned

Jan 28, 2016

Organization subpart

No

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

Authorized official

Name

William F Vorder Bruegge, M.D,NPI 1548293855

Title

Owner

Phone

(910) 323-5203

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Listed as

Fayetteville Gastroenterology Endoscopy Center LLCCCN 34C0001115

Medicare certification status

ActiveFrom the Provider of Services file

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William F. Vorder Bruegge, M.D.

  • Gastroenterology Physician
  • Fayetteville, NC
  • NPI 1548293855
  NPD Authorized official
• Anthony M Daniels, MD

  • Gastroenterology Physician
  • Fayetteville, NC
  • NPI 1558398511
  NPD (past)
• John E. Poulos, M.D.

  • Gastroenterology Physician
  • Fayetteville, NC
  • NPI 1578596896
  NPD (past)

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

{
    "created_epoch": "1453939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618358400000",
    "number": "1962869446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 VALLEYGATE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043745",
            "telephone_number": "910-323-5203",
            "fax_number": "910-323-3650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 VALLEYGATE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043745",
            "telephone_number": "910-323-5203",
            "fax_number": "910-323-3650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-28",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A",
        "authorized_official_last_name": "VORDER BRUEGGE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-323-5203",
        "authorized_official_credential": "M.D,"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Q591940001",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Fayetteville Laser Center PLLC

• Ambulatory Surgical Clinic/Center in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Ambulatory Surgical Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; 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.