NPIMap

Organization Active NPI

Radiation Oncology Centers of the Carolinas, Inc.

Doing business as Lake Norman Radiation Oncology Center

  • Radiation Oncology Physician
  • Mooresville, NC
National Provider Identifier
1023055365
Registry record updated Dec 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
RADIATION ONCOLOGY CENTERS OF THE CAROLINAS, INC.
Doing business as
Lake Norman Radiation Oncology Center
Practice address
170 Medical Park Rd
Suite 100
Mooresville, NC 28117-8521
Phone
(704) 235-2580
Fax
(704) 235-2599
NPI assigned
Jun 2, 2006
Last updated
Dec 4, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
RADIATION ONCOLOGY CENTERS OF THE CAROLINAS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 4, 2012

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

Authorized official

Name
Candice Ann Barker
Title
Credentialing Specialist
Phone
(704) 333-7376

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X NU Primary

Addresses

Primary practice location

170 Medical Park Rd
Suite 100
Mooresville, NC 28117-8521

Mailing address

200 Queens Rd
Suite 400
Charlotte, NC 28204-3252
Phone (704) 333-7376

Other identifiers 4

IdentifierTypeStateIssuer
5902249MedicaidNC
GPO441MedicaidSC
2572429OtherUNITED HEALTHCARE
017JPOtherNCBLUE CROSS

Other names 1

  • Lake Norman Radiation Oncology Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041008001119 NC Part B Supplier - Clinic/Group Practice 7810956380 Receives reassigned benefits from 43 practitioners
2 other NPIs on this enrollment
Practice locations: Matthews, NC; Mooresville, NC

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Matthews Rad Oncology Inc

Locations

8310 University Exec Park Dr
Ste 500
Charlotte, NC 28262
Phone (704) 547-8762

Practitioners & affiliated clinicians

Practitioners 57

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 57

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354579200000",
    "number": "1023055365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 QUEENS RD",
            "address_2": "SUITE 400",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043252",
            "telephone_number": "704-333-7376",
            "fax_number": "704-333-3397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 MEDICAL PARK RD",
            "address_2": "SUITE 100",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178521",
            "telephone_number": "704-235-2580",
            "fax_number": "704-235-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIATION ONCOLOGY CENTERS OF THE CAROLINAS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RADIATION ONCOLOGY CENTERS OF THE CAROLINAS, INC.",
        "enumeration_date": "2006-06-02",
        "last_updated": "2012-12-04",
        "status": "A",
        "authorized_official_last_name": "BARKER",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "704-333-7376"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902249",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPO441",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2572429",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "017JP",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Norman Radiation Oncology Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; 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.