Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Disney Kulachati Samutsakorn, PA-C

Individual provider Physician Assistant · NPI 1255875571

Disney Kulachati Samutsakorn, PA-C is a Physician Assistant in Fort Bragg, North Carolina. Qualified in 2023, 3 years ago. Practices with Cfv Express Care Billing Services LLC, a 20-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
3
Licensed in
NC
In the registry since
2016
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

2817 Rock Merritt Ave
Fort Bragg, NC 28310-4504
Phone: (910) 907-8922
Fax: (910) 907-6069
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 150 Robeson St, Fayetteville, NC 28301-5519 — (910) 615-1059
  • 1638 Owen Dr, Fayetteville, NC 28304-3424 — (910) 615-6949
  • 6387 Ramsey St Unit 100, Fayetteville, NC 28311-9442 — (910) 615-7070

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 1138817 (NC)

Record details

NPI number1255875571
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedDecember 5, 2016
Last updated in NPPESJune 11, 2026
Certification dateJune 11, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Cfv Express Care Billing Services Llc — 20 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Fort Bragg