NPIMap

Organization Active NPI

Carolinas Medical Center

Doing business as Atrium Health Community Care Primary Care West Blvd Family Medicine

  • Internal Medicine Physician
  • Charlotte, NC
National Provider Identifier
1073754131
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CAROLINAS MEDICAL CENTER
Doing business as
Atrium Health Community Care Primary Care West Blvd Family Medicine
CMC Faculty Physicians
Practice address
1350 S Kings Dr
Charlotte, NC 28207-2134
Phone
(704) 446-1242
NPI assigned
Mar 18, 2009
Last updated
Feb 27, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROLINAS MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Authorized official

Name
Scott Rissmiller
Title
Evp & Chief Physician Executive
Phone
(704) 631-0002

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Sports Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0010X

Addresses

Primary practice location

1350 S Kings Dr
Charlotte, NC 28207-2134

Mailing address

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

Other practice location 1

1940 West Blvd
Charlotte, NC 28208-0000
Phone (980) 402-1660

Other practice location 2

4525 Cameron Valley Pkwy
Ste 1600
Charlotte, NC 28211-4369
Phone (704) 512-3800

Other names 2

  • Atrium Health Community Care Primary Care West Blvd Family Medicine Doing business as
  • CMC Faculty Physicians Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
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
O20031110000116 NC Part B Supplier - Clinic/Group Practice 4789597477 Receives reassigned benefits from 2,635 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 30

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

View all 30

National Provider Directory

National Provider Directory
Part of
CMC Randloph

Locations

2001 Vail Ave
Ste 400
Charlotte, NC 28207
Phone (704) 304-7000

16740 Davidson Concord Rd
Ste 200
Davidson, NC 28036
Phone (704) 444-5881

Practitioners & affiliated clinicians

Practitioners 159

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.

View all 159

NPI Registry JSON

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

{
    "created_epoch": "1237334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1073754131",
    "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": "1350 S KINGS DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282072134",
            "telephone_number": "704-446-1242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1940 West Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282080000",
            "country_code": "US",
            "telephone_number": "980-402-1660",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4525 Cameron Valley Pkwy",
            "address_2": "Ste 1600",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282114369",
            "country_code": "US",
            "telephone_number": "704-512-3800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAROLINAS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS MEDICAL CENTER",
        "enumeration_date": "2009-03-18",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "RISSMILLER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "EVP & CHIEF PHYSICIAN EXECUTIVE",
        "authorized_official_telephone_number": "704-631-0002"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1350 S Kings Dr",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282072134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Atrium Health Community Care Primary Care West Blvd Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Atrium Health Community Care Primary Care West Blvd Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CMC Faculty Physicians",
            "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 Feb 27, 2024; 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.