Active NPI
Daniel L McClellan, M.D.
- Surgery Physician
- Gastonia, NC
National Provider Identifier
1053332858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 39851
- Practice address
- 2544 Court Dr
Suite G
Gastonia, NC 28054-3450 - Phone
- (704) 864-7821
- Fax
- (704) 865-0519
- NPI assigned
- Jul 21, 2006
- Last updated
- Apr 27, 2010
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 39851 | NC | Primary |
Addresses
Primary practice location
2544 Court Dr
Suite G
Gastonia, NC 28054-3450
Mailing address
2544 Court Dr
Suite G
Gastonia, NC 28054-3450
Phone (704) 864-7821
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8955767 | Medicaid | NC | |
| N39851 | Other | SC | SC MEDICAID |
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
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| GS CMG LLC | Surgery | 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": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272326400000",
"number": "1053332858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2544 COURT DR",
"address_2": "SUITE G",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280543450",
"telephone_number": "704-864-7821",
"fax_number": "704-865-0519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2544 COURT DR",
"address_2": "SUITE G",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280543450",
"telephone_number": "704-864-7821",
"fax_number": "704-865-0519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLELLAN",
"first_name": "DANIEL",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2010-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "39851",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8955767",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SC MEDICAID",
"identifier": "N39851",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gastonia, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.