Fayetteville Pulmonology Critical Care PC

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

95-01525 Issued in NC

Legal business name

FAYETTEVILLE PULMONOLOGY CRITICAL CARE PC

Practice address

1205 Cape CT
Suite a
Fayetteville, NC 28304-4404

Phone

(910) 678-8611

Fax

(910) 678-8100

NPI assigned

Oct 2, 2006

Last updated

Jan 14, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gautam Dev, MDNPI 1437126224

Title

Medical Doctor President

Phone

(910) 678-8611

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

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.

• Gautam Dev, MD

  • Pulmonary Disease Physician
  • Fayetteville, NC
  • NPI 1437126224
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1982797072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 CAPE CT",
            "address_2": "SUITE A",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044404",
            "telephone_number": "910-678-8611",
            "fax_number": "910-678-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 CAPE CT",
            "address_2": "SUITE A",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044404",
            "telephone_number": "910-678-8611",
            "fax_number": "910-678-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE PULMONOLOGY CRITICAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "DEV",
        "authorized_official_first_name": "GAUTAM",
        "authorized_official_title_or_position": "MEDICAL DOCTOR PRESIDENT",
        "authorized_official_telephone_number": "910-678-8611",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NC",
            "license": "95-01525",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NC",
            "license": "95-01525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0134J",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890134J",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Fayetteville Physical Therapy & Rehab LLC
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• Fayetteville Sleep Appliances LLC
• Fayetteville State University
• Fayetteville State University
• Fayetteville State University
• Fayetteville State University/Dept of Nursing

• Pulmonary Disease Physician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Pulmonary Disease Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; 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.