Organization Active NPI

Scotland Regional Health Network

  • Family Medicine Physician
  • Wagram, NC
National Provider Identifier
1982913422
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SCOTLAND REGIONAL HEALTH NETWORK
Practice address
24420 Marlboro Street
Wagram, NC 28396-9600
Phone
(919) 369-3136
Fax
(910) 369-4756
NPI assigned
Oct 1, 2010
Organization subpart
Yes
Parent organization
SCOTLAND REGIONAL HEALTH NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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

Authorized official

Name
Mathew David Pracht
Title
Treasurer
Phone
(910) 291-7920

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

24420 Marlboro Street
Wagram, NC 28396-9600

Mailing address

PO Box 602458
Charlotte, NC 28260-2458
Phone (910) 369-3136

Other identifiers 3

IdentifierTypeStateIssuer
NPB433MedicaidSC
1982913422MedicaidNC
5916876MedicaidNC

Other names 1

  • Wagram Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100623000242 NC Part B Supplier - Clinic/Group Practice 2365573185 Receives reassigned benefits from 282 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Laurinburg, NC; Pembroke, NC

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Part of
Scotland Regional Health Network

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1285891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484092800000",
    "number": "1982913422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602458",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602458",
            "telephone_number": "910-369-3136",
            "fax_number": "910-369-4756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24420 MARLBORO STREET",
            "city": "WAGRAM",
            "state": "NC",
            "postal_code": "283969600",
            "telephone_number": "919-369-3136",
            "fax_number": "910-369-4756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTLAND REGIONAL HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SCOTLAND REGIONAL HEALTH NETWORK",
        "enumeration_date": "2010-10-01",
        "last_updated": "2017-01-11",
        "status": "A",
        "authorized_official_last_name": "PRACHT",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "910-291-7920"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPB433",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982913422",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5916876",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wagram Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wagram, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; 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.