NPIMap

Organization Active NPI

Cumberland County Hospital System Inc

  • Internal Medicine Physician
  • Fayetteville, NC
National Provider Identifier
1972507440
Registry record updated Dec 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CUMBERLAND COUNTY HOSPITAL SYSTEM INC
Practice address
101 Robeson St Ste 300
Fayetteville, NC 28301-5520
Phone
(910) 615-1617
Fax
(910) 615-1618
NPI assigned
Jun 13, 2005
Organization subpart
No

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

Practitioners 2

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

Affiliated clinicians 900

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 900

Care Compare: Hospital

Medicare Care Compare
Listed as
Cape Fear Valley Medical CenterCCN 340028
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
34D0931199Cfvhs-Cape Fear Valley Internal Med101 Robeson Street, Suite 300 Medical Arts BLDG, Fayetteville, NC 28301Certificate of waiverJul 23, 2027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031112000693 NC Part B Supplier - Clinic/Group Practice 1850204041 Receives reassigned benefits from 1,012 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Fayetteville, NC; Lillington, NC; Lumberton, NC; Raeford, NC; Red Springs, NC; Spring Lake, NC; Stedman, NC; Angier, NC…
O20031119000750 NC Part A Provider - Hospital 1850204041 13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stedman, NC; Raeford, NC; Fayetteville, NC

Hospital certification: CCN 340028

Legal name
CUMBERLAND COUNTY HOSPITAL SYSTEM INC
Doing business as
CAPE FEAR VALLEY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 10, 2013
Beds
600 (594 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jul 7, 1964 in NC
Enrollment address
1638 Owen Dr
Fayetteville, NC 28304-3424
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Rehabilitation unit, Other

Facilities connected through Provider of Services related, parent or unit certification numbers.

All disclosed owners & managing parties 23

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Henry Culbreath Tyson Individual Corporate DirectorTrustee Dec 1, 2024
Veronica Brunell Jones Individual Corporate DirectorTrustee Dec 31, 2022
Shannon Alane Matthews Individual Corporate DirectorTrustee Dec 31, 2022
Jeannette Council Individual Corporate DirectorTrustee Aug 7, 2000
Ryan Aul Individual Corporate DirectorTrustee Jun 17, 2022
Michael Reesal Jones Individual W-2 Managing EmployeeTrustee Jun 17, 2022
Pamela Suggs Story Individual Corporate DirectorTrustee Dec 31, 2022
Glenn Adams Individual Corporate DirectorTrustee Feb 1, 2016
Moses Y Aboagye Kumi Individual Corporate DirectorTrustee Dec 1, 2024
Girum K Feyissa Individual W-2 Managing EmployeeTrustee Jun 17, 2022
Michael Nagowski Individual Corporate OfficerChief Executive Officer Jan 14, 2008
W-2 Managing EmployeeChief Executive Officer Jan 14, 2008
Sanjay B Shah Individual Corporate DirectorTrustee Dec 31, 2022
Afua Ottie Arhin Individual Corporate DirectorTrustee Sep 1, 2023
Bret Johnson Individual W-2 Managing EmployeeCfo Jun 17, 2022
Myron Scott Strickland Individual Corporate DirectorTrustee Jun 17, 2022
Joseph Fiser Individual Corporate DirectorVP Corp Rev Cycle/Managed Care Feb 12, 2012
W-2 Managing EmployeeVP Corporate Rev Cycle/Managed Care Feb 12, 2012
Ernest West Jones Individual Corporate DirectorTrustee Sep 1, 2023
William Faircloth Individual Corporate DirectorTrustee Dec 22, 2008
Kirk Joseph Deviere Individual Corporate DirectorTrustee Dec 1, 2024
Samuel a Fleishman Individual W-2 Managing EmployeeMedical Director Jun 17, 2022
Kelvin Eric Farmer Individual Corporate DirectorTrustee Dec 1, 2024
Terrill F Brown Individual Corporate DirectorTrustee Sep 1, 2023
Pavi Divyang Patel Individual Corporate DirectorTrustee Dec 1, 2024

National Provider Directory

National Provider Directory
Tax ID family
Cumberland County EMS50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

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

View all 49

NPPES NPI Registry

Updated by the provider on Dec 26, 2023

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

Authorized official

Name
Joseph B Fiser
Title
VP Managed Care and Revenue Cycle
Phone
(910) 615-5572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

101 Robeson St Ste 300
Fayetteville, NC 28301-5520

Mailing address

PO Box 40908
Fayetteville, NC 28309-0908
Phone (910) 615-6949

Other identifiers 1

IdentifierTypeStateIssuer
890269YMedicaidNC

Other names 1

  • Cape Fear Valley Internal Medicine Doing business as

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703548800000",
    "number": "1972507440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40908",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283090908",
            "telephone_number": "910-615-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 ROBESON ST STE 300",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015520",
            "telephone_number": "910-615-1617",
            "fax_number": "910-615-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND COUNTY HOSPITAL SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-26",
        "status": "A",
        "authorized_official_last_name": "FISER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "VP MANAGED CARE AND REVENUE CYCLE",
        "authorized_official_telephone_number": "910-615-5572"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890269Y",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cape Fear Valley Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cape Fear Valley Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.