NPIMap

Organization Active NPI

CMC-Northeast, Inc.

  • Pediatrics Physician
  • Huntersville, NC
National Provider Identifier
1023161726
Registry record updated Feb 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CMC-NORTHEAST, INC.
Doing business as
Pediatric Pavilion at Huntersville
Practice address
16623 Birkdale CMNS Pkwy
Suite 110 Pediatric Pavilion at Huntersville
Huntersville, NC 28078-5621
Phone
(704) 987-4277
Fax
(704) 987-5096
NPI assigned
Jan 18, 2007
Organization subpart
Yes
Parent organization
CMC-NORTHEAST, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 5, 2009

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

Authorized official

Name
Frieda M Lowder
Title
VP Physician Serv
Phone
(704) 403-4146

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Pediatric Neurodevelopmental Disabilities PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0008X
Pediatric Endocrinology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0205X

Addresses

Primary practice location

16623 Birkdale CMNS Pkwy
Suite 110 Pediatric Pavilion at Huntersville
Huntersville, NC 28078-5621

Mailing address

16623 Birkdale CMNS Pkwy
Suite 110 Pediatric Pavilion at Huntersville
Huntersville, NC 28078-5621
Phone (704) 987-4277

Other identifiers 4

IdentifierTypeStateIssuer
355573OtherNCMAMSI
566000156020OtherNCTRICARE STANDARD, NON NWK
5904836MedicaidNC
5906850MedicaidNC

Other names 1

  • Pediatric Pavilion at Huntersville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CMC Northeast44 organizations share this tax ID, including this one
Part of
CMC Northeast

Other organizations with this tax ID 43

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

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233792000000",
    "number": "1023161726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16623 BIRKDALE CMNS PKWY",
            "address_2": "SUITE 110 PEDIATRIC PAVILION AT HUNTERSVILLE",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280785621",
            "telephone_number": "704-987-4277",
            "fax_number": "704-987-5096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16623 BIRKDALE CMNS PKWY",
            "address_2": "SUITE 110 PEDIATRIC PAVILION AT HUNTERSVILLE",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280785621",
            "telephone_number": "704-987-4277",
            "fax_number": "704-987-5096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMC-NORTHEAST, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CMC-NORTHEAST, INC.",
        "enumeration_date": "2007-01-18",
        "last_updated": "2009-02-05",
        "status": "A",
        "authorized_official_last_name": "LOWDER",
        "authorized_official_first_name": "FRIEDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP PHYSICIAN SERV",
        "authorized_official_telephone_number": "704-403-4146"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "355573",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE STANDARD, NON NWK",
            "identifier": "566000156020",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5904836",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5906850",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Pavilion at Huntersville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2009; 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.