NPIMap

Individual provider Active NPI

Linda Renee Coverdale, P.A.

  • Medical Physician Assistant
  • Charlotte, NC
National Provider Identifier
1063795995
Registry record updated Jul 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
001003106 Issued in NC
Practice address
200 Queens Rd
Suite 400
Charlotte, NC 28204-3253
Phone
(704) 333-7376
Fax
(704) 333-3397
NPI assigned
Sep 27, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 001003106 NC Primary

Addresses

Primary practice location

200 Queens Rd
Suite 400
Charlotte, NC 28204-3253

Mailing address

200 Queens Rd
Suite 400
Charlotte, NC 28204-3253
Phone (704) 333-7376

Other identifiers 1

IdentifierTypeStateIssuer
232009OtherNCMEDICARE PTAN GROUP, CMCNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250417000045 NC Practitioner - Physician Assistant 3476726902 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Radiation Oncology Group, P.a.Group PAC ID 1254233950, 52 clinicians

Practice addresses (Care Compare)

200 Queens Rd
Charlotte, NC 28204-3264
Phone (704) 333-7376

920 Church N St
Concord, NC 28025-2927
Phone (704) 333-7376

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

State licenses

LicenseStateTypeSpecialty
001003106NCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Radiation Oncology Centers of the Carolinas, Inc. CurrentSince May 7, 2025 Accepting new patients
Radiation Oncology Centers of the Carolinas, Inc. CurrentSince May 7, 2025 Accepting new patients

Locations

200 Queens Rd
Ste 400
Charlotte, NC 28204
Phone (704) 765-2578

1400 Matthews Township Pkwy
Matthews, NC 28105
Phone (704) 845-8800

Interoperability endpoints

  • Direct secure messaging: lcoverdale3000485@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1317081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437523200000",
    "number": "1063795995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 QUEENS RD",
            "address_2": "SUITE 400",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043253",
            "telephone_number": "704-333-7376",
            "fax_number": "704-333-3397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 QUEENS RD",
            "address_2": "SUITE 400",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043253",
            "telephone_number": "704-333-7376",
            "fax_number": "704-333-3397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COVERDALE",
        "first_name": "LINDA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-27",
        "last_updated": "2015-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "001003106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN GROUP, CMCNE",
            "identifier": "232009",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.