Individual provider Active NPI

Theresa Aileen Virsik, R.D., C.D.E

  • Registered Dietitian
  • Charlotte, NC
National Provider Identifier
1043262413
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
L008189 Issued in NC
Practice address
2225 Freedom Dr
Charlotte, NC 28208-1000
Phone
(704) 384-7390
Fax
(704) 384-5669
NPI assigned
May 16, 2006
Last updated
Apr 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 864112 FL
Registered Dietitian 133V00000X L008189 NC Primary

Addresses

Primary practice location

2225 Freedom Dr
Charlotte, NC 28208-1000

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

Brevard VA Outpatient Clinic
2900 Veterans Way
Melbourne, FL 32940
Phone (321) 637-3788 ext. 2776

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250505002659 NC Practitioner - Registered Dietitian Or Nutrition Professional 7012434954 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

1918 Randolph Rd
Suite 220
Charlotte, NC 28207-1109
Phone (704) 316-1125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
864112FLMDRegistered Dietitian
L008189NCMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Mar 2, 2025 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Mar 2, 2025 Accepting new patients
Novant Medical Group, Inc. Past Accepting new patients

Locations

1918 Randolph Rd
Ste 220
Charlotte, NC 28207
Phone (704) 316-1125

2225 Freedom Dr
Charlotte, NC 28208
Phone (704) 316-5166

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1043262413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 FREEDOM DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282081000",
            "telephone_number": "704-384-7390",
            "fax_number": "704-384-5669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Brevard VA Outpatient Clinic",
            "address_2": "2900 Veterans Way",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "32940",
            "country_code": "US",
            "telephone_number": "321-637-3788 x2776",
            "fax_number": "321-637-3648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIRSIK",
        "first_name": "THERESA",
        "middle_name": "AILEEN",
        "name_prefix": "Mrs.",
        "credential": "R.D., C.D.E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "864112",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L008189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.