NPIMap

Organization Active NPI

Primedoc Park Ridge PA

  • Internal Medicine Physician
  • Hendersonville, NC
National Provider Identifier
1023198728
Registry record updated Mar 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
N/A
Legal business name
PRIMEDOC PARK RIDGE PA
Practice address
100 Hospital Dr
Hendersonville, NC 28792-5272
Phone
(843) 237-3378
Fax
(843) 237-5073
NPI assigned
Oct 17, 2006
Last updated
Mar 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2009

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

Authorized official

Name
Robert Reynolds, MDNPI 1861453383
Title
President Owner
Phone
(843) 237-3378

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X N/A Primary

Addresses

Primary practice location

100 Hospital Dr
Hendersonville, NC 28792-5272

Mailing address

PO Box 60262
Charlotte, NC 28260-0262
Phone (843) 237-3378

Other identifiers 2

IdentifierTypeStateIssuer
018NXOtherNCBLUE CROSS BLUE SHIELD
5905717MedicaidNC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237161600000",
    "number": "1023198728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60262",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600262",
            "telephone_number": "843-237-3378",
            "fax_number": "843-237-5073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DR",
            "city": "HENDERSONVILLE",
            "state": "NC",
            "postal_code": "287925272",
            "telephone_number": "843-237-3378",
            "fax_number": "843-237-5073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMEDOC PARK RIDGE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2009-03-16",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "843-237-3378",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": "N/A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "018NX",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905717",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hendersonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.