NPIMap

Organization Active NPI

Gastonia Medical Specialty Clinic PA

  • Internal Medicine Physician
  • Gastonia, NC
National Provider Identifier
1023048279
Registry record updated Oct 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GASTONIA MEDICAL SPECIALTY CLINIC PA
Practice address
1021 X Ray Dr
Gastonia, NC 28054-7489
Phone
(704) 867-2341
Fax
(704) 867-9019
NPI assigned
Jul 4, 2006
Last updated
Oct 8, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2014

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

Authorized official

Name
Mikell J Jarratt, MDNPI 1497785604
Title
Corporate Officer - President
Phone
(704) 867-2341

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

1021 X Ray Dr
Gastonia, NC 28054-7489

Mailing address

1021 X Ray Dr
Gastonia, NC 28054-7489
Phone (704) 867-2341

Other identifiers 4

IdentifierTypeStateIssuer
01627OtherNCBCBSNC GROUP PROVIDER #
CC5252OtherNCRAILROAD MEDICARE
NPA701MedicaidSC
5920537MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061121000682 NC Part B Supplier - Clinic/Group Practice 2961400197 Receives reassigned benefits from 9 practitioners
Practice locations: Gastonia, NC

National Provider Directory

National Provider Directory
Tax ID family
Gastonia Medical Specialty Clinic PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.61582

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412726400000",
    "number": "1023048279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 X RAY DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280547489",
            "telephone_number": "704-867-2341",
            "fax_number": "704-867-9019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 X RAY DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280547489",
            "telephone_number": "704-867-2341",
            "fax_number": "704-867-9019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTONIA MEDICAL SPECIALTY CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2014-10-08",
        "status": "A",
        "authorized_official_last_name": "JARRATT",
        "authorized_official_first_name": "MIKELL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CORPORATE OFFICER - PRESIDENT",
        "authorized_official_telephone_number": "704-867-2341",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC GROUP PROVIDER #",
            "identifier": "01627",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC5252",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPA701",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5920537",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2014; 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.