Active NPI
Thomas C Sundberg, M.D.
- Rheumatology Physician
- Charlotte, NC
National Provider Identifier
1063433456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- 25958
- Practice address
- 4525 Cameron Valley Pkwy
Suite 4100
Charlotte, NC 28211-4378 - Phone
- (704) 302-9300
- Fax
- (704) 302-9301
- NPI assigned
- Jul 21, 2006
- 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 |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | 25958 | NC | Primary |
Addresses
Primary practice location
4525 Cameron Valley Pkwy
Suite 4100
Charlotte, NC 28211-4378
Mailing address
PO Box 601643
Charlotte, NC 28260-1643
Phone (704) 302-9300
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 660003567 | Other | NC | MEDICARE-RR |
| 80105 | Other | NC | BCBSNC |
| 8980105 | Medicaid | NC | |
| 1063433456 | Medicaid | NC | |
| N25958 | Medicaid | SC |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25958 | NC | MD | Rheumatology Physician |
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": "1480982400000",
"number": "1063433456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 601643",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282601643",
"telephone_number": "704-302-9300",
"fax_number": "704-302-9301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4525 CAMERON VALLEY PKWY",
"address_2": "SUITE 4100",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282114378",
"telephone_number": "704-302-9300",
"fax_number": "704-302-9301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUNDBERG",
"first_name": "THOMAS",
"middle_name": "C",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2016-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "NC",
"license": "25958",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE-RR",
"identifier": "660003567",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSNC",
"identifier": "80105",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8980105",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1063433456",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "N25958",
"state": "SC"
}
],
"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 Dec 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.