Active NPI
John Creekmore, SA-C
- Surgical Assistant
- Charlotte, NC
National Provider Identifier
1043508229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 3155
- Practice address
- 8000 Waterford Tide Loop
#2931
Charlotte, NC 28226 - Phone
- (336) 425-5991
- NPI assigned
- Jul 21, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 3155 | OH | Primary |
Addresses
Primary practice location
8000 Waterford Tide Loop
#2931
Charlotte, NC 28226
Mailing address
8000 Waterford Tide Loop
#2931
Charlotte, NC 28226
Phone (336) 425-5991
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3155 | OH | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | 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 and National Provider Directory roles.
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311206400000",
"number": "1043508229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8000 WATERFORD TIDE LOOP",
"address_2": "#2931",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28226",
"telephone_number": "336-425-5991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8000 WATERFORD TIDE LOOP",
"address_2": "#2931",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28226",
"telephone_number": "336-425-5991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CREEKMORE",
"first_name": "JOHN",
"name_prefix": "Mr.",
"credential": "SA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-07-21",
"last_updated": "2011-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "OH",
"license": "3155",
"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 Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.