Pavana Treatment Group, P.C.

Primary specialty

Addiction Medicine (Anesthesiology) PhysicianTaxonomy code 207LA0401X

Legal business name

PAVANA TREATMENT GROUP, P.C.

Practice address

1560 Union Rd
Gastonia, NC 28054-2209

Phone

(704) 490-4993

NPI assigned

Apr 3, 2020

Organization subpart

No

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

Authorized official

Name

Melissa Blocker

Title

Cfo

Phone

(864) 800-3223

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicole Metcalf Beal, NP

  • Nurse Practitioner
  • Newton, NC
  • NPI 1518539691
  Medicare reassignment Care Compare group NPD
• Robert Gareth Ellis, MD

  • Anesthesiology Physician
  • Concord, NC
  • NPI 1851598130

  Addiction Medicine

  Medicare reassignment Care Compare group NPD
• Ashetyn Taylor Owen, PA-C

  • Physician Assistant
  • Matthews, NC
  • NPI 1225885064
  Medicare reassignment Care Compare group NPD
• Tiffany Joyce Ulu

  • Physician Assistant
  • Fayetteville, NC
  • NPI 1285392431
  Medicare reassignment Care Compare group
• Amy Vongvilath Lane, F-NP

  • Nurse Practitioner
  • Huntersville, NC
  • NPI 1477149730
  Medicare reassignment NPD
• Dawn Lorraine McNeely, FNP-BC

  • Family Nurse Practitioner
  • Hickory, NC
  • NPI 1871008649
  Medicare reassignment NPD
• Stacey Stroh Rabindran, FNP

  • Family Nurse Practitioner
  • Charlotte, NC
  • NPI 1811371438
  Medicare reassignment NPD
• Rostislav Markovich Beyder, PA-C

  • Physician Assistant
  • Charlotte, NC
  • NPI 1528341864
  Medicare reassignment

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

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1043849896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 UNION RD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542209",
            "telephone_number": "704-490-4993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 UNION RD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542209",
            "telephone_number": "704-490-4993"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1309 E Sunset Dr",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "NC",
            "postal_code": "281124324",
            "country_code": "US",
            "telephone_number": "704-490-4993",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1909 Bragg Blvd Ste 94",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283034386",
            "country_code": "US",
            "telephone_number": "984-246-5300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PAVANA TREATMENT GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-03",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "BLOCKER",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "864-800-3223"
    },
    "taxonomies": [
        {
            "code": "207LA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043849896",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer L Patton, OTR/L
• Scott Allan Patton, REGISTERED NURSE
• Rudra Paudel
• Jennifer Lynn Mengel Paul, MSW, LCSWA
• Evelyn Nicole Alexander Pauling, MBA, PHARMD
• Keith Pawlish Jr., O.D.
• Bryan P. Payne, D.O.
• Susan Paulette Payne, NP
• Nora Davis Paysour, FNP-C
• Charles Arthur Peach, M.D.

• Anesthesiology Physician in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Anesthesiology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; 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.