NPIMap

Organization Active NPI

University Pediatrics

  • Pediatrics Physician
  • Charlotte, NC
National Provider Identifier
1073541124
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
UNIVERSITY PEDIATRICS
Practice address
101 E W T Harris Blvd
Ste 1121
Charlotte, NC 28262-3485
Phone
(704) 717-2000
NPI assigned
Jun 29, 2006
Organization subpart
Yes
Parent organization
UNIVERSITY PEDIATRICSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Authorized official

Name
Scott Rissmiller
Title
Enterprise Evp
Phone
(704) 355-8675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

101 E W T Harris Blvd
Ste 1121
Charlotte, NC 28262-3485

Mailing address

PO Box 19305
Charlotte, NC 28219-9305
Phone (704) 631-0002

Other names 2

  • Atrium Health Levine Children's University Pediatrics Doing business as
  • University Pediatrics Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network
Direct Messaging Address Ambulatory@direct.carolinashealthcare.org Atrium Health

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110727000416 NC Part B Supplier - Clinic/Group Practice 1951579481 Receives reassigned benefits from 31 practitioners
2 other NPIs on this enrollment
Practice locations: Shelby, NC; Monroe, NC; Lincolnton, ND; Kings Mountain, NC; Concord, NC; Charlotte, NC; Albemarle, NC

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
University Pediatric2 organizations share this tax ID, including this one
Part of
University Pediatric

Other organizations with this tax ID 1

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

Locations

101 W W T Harris Blvd Ste 1121
Charlotte, NC 28262

8605 Cliff Cameron Dr
Ste 120
Charlotte, NC 28269
Phone (704) 548-9947

5435 Prosperity Church Rd Ste 15
Charlotte, NC 28269

101 E Wt Harris Blvd
Ste 2221
Charlotte, NC 28262

Practitioners & affiliated clinicians

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678320000000",
    "number": "1073541124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305",
            "telephone_number": "704-631-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E W T HARRIS BLVD",
            "address_2": "STE 1121",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282623485",
            "telephone_number": "704-717-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PEDIATRICS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSITY PEDIATRICS",
        "enumeration_date": "2006-06-29",
        "last_updated": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "RISSMILLER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "ENTERPRISE EVP",
        "authorized_official_telephone_number": "704-355-8675"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "101 E W T Harris Blvd",
            "address_2": "Ste 1121",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282623485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Atrium Health Levine Children's University Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 9, 2023; 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.