Bomray Medical Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

BOMRAY MEDICAL CLINIC

Practice address

3627 Beatties Ford Rd
Charlotte, NC 28216-3249

Phone

(704) 335-0806

Fax

(704) 334-2073

NPI assigned

Apr 26, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Jerri Olszewski

Title

Billing Representative

Phone

(704) 335-0806

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• PrimeCare Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Patrick E Evivie, MD

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1285612374
  Medicare reassignment NPD
• Hans Mawuli Kwaku, M.D.

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1689630691
  Medicare reassignment NPD
• Kim Kerry Neely, PAC

  • Physician Assistant
  • Statesville, NC
  • NPI 1912084013
  Medicare reassignment
• Alicia Bullough, PA-C

  • Physician Assistant
  • Charlotte, NC
  • NPI 1215894217
  NPD (past)
• Alison Dizon

  • Family Nurse Practitioner
  • Charlotte, NC
  • NPI 1073428892
  NPD (past)
• Corey Alexander May, DPT

  • Physical Therapist
  • Garner, NC
  • NPI 1508938598
  NPD (past)
• Rahsan Demarcus McMillan, PT, DPT

  • Physical Therapist
  • Charlotte, NC
  • NPI 1417418039
  NPD (past)
• Leon R Anderson III, P.T.

  • Orthopedic Physical Therapist
  • Beachwood, OH
  • NPI 1669413910
  NPD (past)
• Cynthia Obiageli Ejoh, APRN

  • Family Nurse Practitioner
  • Farmers Branch, TX
  • NPI 1124844303
  NPD (past)

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279584000000",
    "number": "1013974864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3627 BEATTIES FORD RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282163249",
            "telephone_number": "704-335-0806",
            "fax_number": "704-334-2073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3627 BEATTIES FORD RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282163249",
            "telephone_number": "704-335-0806",
            "fax_number": "704-334-2073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOMRAY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2010-07-20",
        "status": "A",
        "authorized_official_last_name": "OLSZEWSKI",
        "authorized_official_first_name": "JERRI",
        "authorized_official_title_or_position": "BILLING REPRESENTATIVE",
        "authorized_official_telephone_number": "704-335-0806",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890271W",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PrimeCare Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joy Rosamond Bolly, LPC
• Sabrina Elsje Bologna, PA-C
• Mohammad R. Bolouri, MD
• Kelley Bolton, PSY.D.
• Michael Anthony Bomar II, MSW, LCSW, LISW-CP
• Bon Laboratory Services Inc
• Amy Bonadies
• Thadius Leonard Bonapart III
• Bond Medical Billing and Coding Services LLC
• Bond of Brothers of America

• Primary Care Clinic/Center in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Primary Care Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.