Individual provider Active NPI

Peter C Fotinos, MD

  • Family Medicine Physician
  • Huntersville, NC
National Provider Identifier
1043243777
Registry record updated Sep 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
200600809 Issued in NC
Practice address
16511 Northcross Dr
Suite a
Huntersville, NC 28078-5021
Phone
(704) 895-3415
Fax
(704) 895-3416
NPI assigned
Jul 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 200600809 NC Primary

Addresses

Primary practice location

16511 Northcross Dr
Suite a
Huntersville, NC 28078-5021

Mailing address

17705 Springwinds Dr
Cornelius, NC 28031-7744
Phone (704) 895-3415

Other identifiers 1

IdentifierTypeStateIssuer
5904368MedicaidNC

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

LicenseStateTypeSpecialty
200600809NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northcross Medical Center PC Family Medicine Past Accepting new patients
North Cross Medical Center PC Family Medicine Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251936000000",
    "number": "1043243777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17705 SPRINGWINDS DR",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280317744",
            "telephone_number": "704-895-3415",
            "fax_number": "704-895-3416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16511 NORTHCROSS DR",
            "address_2": "SUITE A",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280785021",
            "telephone_number": "704-895-3415",
            "fax_number": "704-895-3416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOTINOS",
        "first_name": "PETER",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2009-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200600809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5904368",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Sep 3, 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.