Active NPI
Kristine Vera Wade, AU.D
- Audiologist-Hearing Aid Fitter
- Concord, NC
National Provider Identifier
1043406036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist-Hearing Aid Fitter
- License
- 736
- Practice address
- 1090 NE Gateway CT NE
Suite 101
Concord, NC 28025-2414 - Phone
- (704) 403-9100
- Fax
- (704) 403-9104
- NPI assigned
- Sep 24, 2007
- Last updated
- Jul 22, 2013
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | 2932 | NC | |
| Audiologist-Hearing Aid Fitter | 237600000X | 736 | NC | Primary |
Addresses
Primary practice location
1090 NE Gateway CT NE
Suite 101
Concord, NC 28025-2414
Mailing address
1090 NE Gateway CT NE
Suite 101
Concord, NC 28025-2414
Phone (704) 403-9100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3404200 | Medicaid | NC | |
| 232009B | Other | NC | MEDICARE GROUP PTAN |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CMC-Northeast, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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": "1190592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374451200000",
"number": "1043406036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1090 NE GATEWAY CT NE",
"address_2": "SUITE 101",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252414",
"telephone_number": "704-403-9100",
"fax_number": "704-403-9104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1090 NE GATEWAY CT NE",
"address_2": "SUITE 101",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252414",
"telephone_number": "704-403-9100",
"fax_number": "704-403-9104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "KRISTINE",
"middle_name": "VERA",
"name_prefix": "Dr.",
"credential": "AU.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-24",
"last_updated": "2013-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "NC",
"license": "2932",
"primary": false
},
{
"code": "237600000X",
"taxonomy_group": "",
"desc": "Audiologist-Hearing Aid Fitter",
"state": "NC",
"license": "736",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3404200",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP PTAN",
"identifier": "232009B",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.