NPIMap

Organization Active NPI

Premise Health of North Carolina Medical, P.C

Doing business as DTNA - Cleveland Truck Occ

  • Multi-Specialty Clinic/Center
  • Cleveland, NC
National Provider Identifier
1063188472
Registry record updated Oct 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C
Doing business as
DTNA - Cleveland Truck Occ
Practice address
11550 Statesville Blvd
Cleveland, NC 27013-8114
Phone
(704) 645-5997
NPI assigned
Aug 17, 2021
Last updated
Oct 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2022

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

Authorized official

Name
Jonathan B Leizman, MDNPI 1447249677
Title
President
Phone
(216) 479-9063

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

11550 Statesville Blvd
Cleveland, NC 27013-8114

Mailing address

5500 Maryland Way
Brentwood, TN 37027-7048

Other names 2

  • DTNA - Cleveland Truck Occ Doing business as
  • CHS North Carolina Medical PC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of North Carolina Medical PC14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

11550 Statesville Blvd
Cleveland, NC 27013
Phone (704) 645-5997

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665273600000",
    "number": "1063188472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11550 STATESVILLE BLVD",
            "city": "CLEVELAND",
            "state": "NC",
            "postal_code": "270138114",
            "telephone_number": "704-645-5997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2022-10-09",
        "certification_date": "2022-10-09",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DTNA - Cleveland Truck Occ",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHS North Carolina Medical PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Cleveland, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.