Individual provider Active NPI

Omer Zulfiqar, M.D.

  • Internal Medicine Physician
  • Charlotte, NC
National Provider Identifier
1043577059
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME136610 Issued in FL
Practice address
1000 Blythe Blvd
CMC Annex 1St Floor
Charlotte, NC 28203
Phone
(704) 355-0720
Fax
(704) 355-5948
NPI assigned
Apr 15, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2014-02272 NC
Internal Medicine Physician 207R00000X ME136610 FL Primary

Addresses

Primary practice location

1000 Blythe Blvd
CMC Annex 1St Floor
Charlotte, NC 28203

Mailing address

3090 Caruso CT Ste 50
Orlando, FL 32806-8510
Phone (407) 481-7179

Other practice location 1

1000 Blythe Blvd
CMC Annex 1st Floor
Charlotte, NC 28203-5812
Phone (704) 355-0720

Other identifiers 2

IdentifierTypeStateIssuer
NC2422MedicaidSC
1043577059MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181126001412 FL Practitioner - Internal Medicine 1759697550 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2014-02272NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc Internal Medicine CurrentSince Sep 1, 2018 Accepting new patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc CurrentSince Sep 1, 2018 Accepting new patients
Columbus Regional Health Network Internal Medicine Past Accepting new patients

Locations

86 Underwood St
Orlando, FL 32806
Phone (321) 841-5142

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: ozulfiqar27220@orlandohealth.medalliesdirect.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1334448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528675200000",
    "number": "1043577059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3090 CARUSO CT STE 50",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328068510",
            "telephone_number": "407-481-7179",
            "fax_number": "407-481-7190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "address_2": "CMC ANNEX 1ST FLOOR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28203",
            "telephone_number": "704-355-0720",
            "fax_number": "704-355-5948"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Blythe Blvd",
            "address_2": "CMC Annex 1st Floor",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035812",
            "country_code": "US",
            "telephone_number": "704-355-0720",
            "fax_number": "704-355-5948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZULFIQAR",
        "first_name": "OMER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-15",
        "last_updated": "2018-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2014-02272",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME136610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NC2422",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043577059",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.