ROY O FAGAN III MD PA NPI 1023291234

Internal Medicine in Reidsville, NC

NPI 1023291234 Organization Internal Medicine CLIA Number 34D0703553 CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP)

About ROY O FAGAN III MD PA

Roy O Fagan Iii Md Pa is an internal medicine provider established in Reidsville, North Carolina specializing in internal medicine. The NPI number of Roy O Fagan Iii Md Pa is 1023291234 and was assigned on December 2007. The practitioner's primary taxonomy code is 207R00000X with license number 37825 (NC). The provider is registered as an organization and their NPI record was last updated 14 years ago. Roy O Fagan Iii Md Pa operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Roy O Fagan Md (President)

An internist like Roy O Fagan Iii Md Pa is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

The CLIA number of Roy O Fagan Iii Md Pa is 34D0703553 registered as a "physician office" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued to Roy O Fagan Iii Md Pa in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.

NPI

1023291234

Provider NameROY O FAGAN III MD PA
Provider Location Address419 W HARRISON ST REIDSVILLE, NC 27320
Provider Mailing Address419 W HARRISON ST REIDSVILLE, NC 27320
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date12-11-2007
Last Update Date12-11-2007


Primary Taxonomy

Taxonomy Code207R00000X
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
License No.37825
License StateNC
Taxonomy DescriptionA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Business Address

ROY O FAGAN III MD PA
419 W HARRISON ST
REIDSVILLE, NC
ZIP 27320
Phone: (336) 342-4448
Fax: (336) 342-4499

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Mailing Address

ROY O FAGAN III MD PA
419 W HARRISON ST
REIDSVILLE, NC
ZIP 27320
Phone: (336) 342-4448
Fax: (336) 342-4499



Authorized Official

Authorized Official Name ROY O FAGAN MD
Authorized Official TitlePRESIDENT
Authorized Official Phone(336) 342-4448

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1023291234 is:

CLIA Number34D0703553
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate for Provider-Performed Microscopy Procedures (PPMP)

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
7931038MEDICAID (05)NC
E04330MEDICARE UPIN (02)NC

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1023075140DR. ROY O FAGAN III MD
Individual
Internal Medicine419 W HARRISON ST
REIDSVILLE, NC 27320
(336) 342-4448

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.