FAYETTEVILLE INTERNAL MEDICINE PLLC
NPI 1417684135
Nurse Practitioner - Family in Fayetteville, NC
About Fayetteville Internal Medicine Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FAYETTEVILLE INTERNAL MEDICINE PLLC (NPI 1417684135) is a healthcare organization registered as a family in Fayetteville, North Carolina and active in the NPI registry since August 2022. The organization lists Jennifer Fortin, Office Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Fayetteville Internal Medicine Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Fayetteville Internal Medicine PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Fayetteville Internal Medicine PLLC's NPI number?
The NPI number for Fayetteville Internal Medicine PLLC is 1417684135. It was assigned to this organization in the NPPES registry on August 3, 2022.
Where is Fayetteville Internal Medicine PLLC located?
Fayetteville Internal Medicine PLLC is located at 1766 Metromedical Dr, Fayetteville, NC 28304. The listed phone number is (910) 483-4856.
What is Fayetteville Internal Medicine PLLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Fayetteville Internal Medicine PLLC enrolled in Medicare?
Yes. Fayetteville Internal Medicine PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Fayetteville Internal Medicine PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Fayetteville Internal Medicine PLLC, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Fayetteville Internal Medicine PLLC was last updated on December 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Fayetteville Internal Medicine Pllc · NPI 1417684135
Family organization in Fayetteville, North Carolina. Organization record, active in the CMS NPPES registry since August 3, 2022.
## Identity
- **NPI:** 1417684135 (Entity type: Organization)
- **Enumerated:** August 3, 2022
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Organization subpart:** No
- **Authorized official:** Jennifer Fortin, OFFICE MANAGER
## Practice location
- **Address:** 1766 METROMEDICAL DR, Fayetteville, NC 28304-3861
- **Phone:** (910) 483-4856
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Nurse Practitioner (1); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 2, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1417684135) · Data from the CMS NPPES public registry.