NPIMap

Organization Active NPI

Charlotte Radiology PA

  • Diagnostic Radiology Physician
  • Charlotte, NC
National Provider Identifier
1003110677
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
CHARLOTTE RADIOLOGY PA
Practice address
1025 Morehead Medical Dr Ste 150
Charlotte, NC 28204-2973
Phone
(704) 362-5391
NPI assigned
Dec 22, 2010
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Jane T Lutz
Title
Manager Payer Privileging
Phone
(704) 362-5391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

1025 Morehead Medical Dr Ste 150
Charlotte, NC 28204-2973

Mailing address

700 E Morehead St Ste 300
Charlotte, NC 28202-2742
Phone (704) 334-7800

Other practice location 1

3816 Latrobe Dr
Charlotte, NC 28211-1167
Phone (704) 909-5960

Other practice location 2

700 E Morehead St Ste 300
Charlotte, NC 28202-2742
Phone (704) 334-7800

Other identifiers 2

IdentifierTypeStateIssuer
5916456MedicaidNC
P00921619OtherNCRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110309000931 NC Part B Supplier - Mammography Center 4587577390 Practice locations: Charlotte, NC
O20130417000089 SC Part B Supplier - Mammography Center 4587577390 Practice locations: Charlotte, NC; Rock Hill, SC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1079319Charlotte Radiology Breast Center - MMP1025 Morehead Medical Drive, Suite 150, Charlotte, NC 28204Certificate of waiverOct 18, 2026

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 121

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.

View all 121

NPI Registry JSON

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

{
    "created_epoch": "1292976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1003110677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E MOREHEAD ST STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282022742",
            "telephone_number": "704-334-7800",
            "fax_number": "704-414-7512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MOREHEAD MEDICAL DR STE 150",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042973",
            "telephone_number": "704-362-5391"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3816 Latrobe Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282111167",
            "country_code": "US",
            "telephone_number": "704-909-5960",
            "fax_number": "704-770-0501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 E Morehead St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282022742",
            "country_code": "US",
            "telephone_number": "704-334-7800",
            "fax_number": "704-414-7512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHARLOTTE RADIOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-22",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "LUTZ",
        "authorized_official_first_name": "JANE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MANAGER PAYER PRIVILEGING",
        "authorized_official_telephone_number": "704-362-5391"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5916456",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00921619",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.