Carolina Specialty Care,PA

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

930036 Issued in NC

Legal business name

CAROLINA SPECIALTY CARE,PA

Practice address

124 Sunset Hill Dr
Statesville, NC 28625-2729

Phone

(704) 872-8711

Fax

(704) 872-5866

NPI assigned

Jan 30, 2007

Last updated

Jul 16, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Robert I Wodecki, MD

Title

Vice -President

Phone

(704) 872-8711

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Carolina Specialty Care, PA

  • Legal Medicine
  • Statesville, NC
  • NPI 1275596439

  O20100726000382

  Same enrollment

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.

• Irma Lee Vazquez-Sanabria

  • Rheumatology Physician
  • Springfield, IL
  • NPI 1649421371
  NPD

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247702400000",
    "number": "1063559193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 SUNSET HILL RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "28625",
            "telephone_number": "704-872-8711",
            "fax_number": "704-872-5866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 SUNSET HILL DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286252729",
            "telephone_number": "704-872-8711",
            "fax_number": "704-872-5866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA SPECIALTY CARE,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2009-07-16",
        "status": "A",
        "authorized_official_last_name": "WODECKI",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "VICE -PRESIDENT",
        "authorized_official_telephone_number": "704-872-8711",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": "NC",
            "license": "930036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016CP",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89014TM",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolina Psych Group, PA
• Carolina Rehab Incorporation
• Carolina Residential Services, Inc
• Carolina Residential Services, Inc
• Carolina Specialty Care, PA
• Carolinas Counseling Solutions Inc.
• Carolinas Physicians Network Inc (The Sanger Clinic)
• Maggie Carpenter, BS-NDTR
• Randy Scott Carpenter, MD
• Elizabeth Raven Carrigan, DNP, FNP-C

• Legal Medicine in Statesville, NC
• Providers in Statesville, NC by specialty
• Legal Medicine in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.