NPIMap

Organization Active NPI

Premise Health of North Carolina Medical, P.C

Doing business as State Health Plan Primary Care Center

  • Family Medicine Physician
  • Canton, NC
National Provider Identifier
1013943646
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C
Doing business as
State Health Plan Primary Care Center
Practice address
121 Park St
Canton, NC 28716-4319
Phone
(828) 235-8414
Fax
(828) 235-9135
NPI assigned
Jun 24, 2006
Last updated
Aug 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Jon Leizman, M.D.
Title
President
Phone
(216) 479-9063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

121 Park St
Canton, NC 28716-4319

Mailing address

5500 Maryland Way Ste 120
Brentwood, TN 37027-4993

Other names 1

  • State Health Plan Primary Care Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of North Carolina Medical PC54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Locations

121 Park St
Canton, NC 28716
Phone (828) 235-8414

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1013943646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 PARK ST",
            "city": "CANTON",
            "state": "NC",
            "postal_code": "287164319",
            "telephone_number": "828-235-8414",
            "fax_number": "828-235-9135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "State Health Plan Primary Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "State Health Plan Primary Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.