Active NPI
Carl Robert Nordstrom, M.D.
- Family Medicine Physician
- Albemarle, NC
National Provider Identifier
1023099181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 22424
- Practice address
- 739 E Oakwood Ave
Albemarle, NC 28001-4249 - Phone
- (704) 550-5860
- NPI assigned
- Nov 7, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0022424 | NC | |
| Family Medicine Physician | 207Q00000X | 22424 | NC | Primary |
Addresses
Primary practice location
739 E Oakwood Ave
Albemarle, NC 28001-4249
Mailing address
739 E Oakwood Ave
Albemarle, NC 28001-4249
Phone (704) 550-5860
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 63026 | Other | NC | BC/BS |
| 080100464 | Other | RAIL ROAD MEDICARE | |
| 8963026 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22424 | NC | MD | Pharmacist |
| 0022424 | NC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hope Medical Care | Family Medicine | Past | Accepting new patients |
| Stanly Medical Services | Past | Accepting new patients | |
| Sovran Senior Living, LLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Assisted Living Facility
- Mount Olive, NC
- NPI 1508134685
-
- Gastroenterology Physician
- Albemarle, NC
- NPI 1174812507
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425513600000",
"number": "1023099181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "739 E OAKWOOD AVE",
"city": "ALBEMARLE",
"state": "NC",
"postal_code": "280014249",
"telephone_number": "704-550-5860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "739 E OAKWOOD AVE",
"city": "ALBEMARLE",
"state": "NC",
"postal_code": "280014249",
"telephone_number": "704-550-5860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NORDSTROM",
"first_name": "CARL",
"middle_name": "ROBERT",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-07",
"last_updated": "2015-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "0022424",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "22424",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "63026",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD MEDICARE",
"identifier": "080100464",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8963026",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albemarle, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.