NPIMap

Individual provider Active NPI

Elise Marie Klesick, DO

  • Emergency Medicine Physician
  • Charlotte, NC
National Provider Identifier
1073975215
Registry record updated May 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2021-00621 Issued in NC
Practice address
1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone
(704) 355-2171
NPI assigned
Mar 27, 2016
Last updated
May 4, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2021-00621 NC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Charlotte, NC 28203-5812

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address eklesick536633@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, VA, GA, WV4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20210608000236 NC Practitioner - Emergency Medicine 1951666312 Reassigns benefits to 7 organizations
I20230512000051 VA Practitioner - Emergency Medicine 1951666312 Reassigns benefits to 1 organization
I20230811002718 GA Practitioner - Emergency Medicine 1951666312 Reassigns benefits to 1 organization
I20240502002281 WV Practitioner - Emergency Medicine 1951666312 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Western Un of HLTH Sciences, Col of Podiatric Med, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Medical CenterGroup PAC ID 4789597477, 1,057 clinicians
Inphynet Primary Care Physicians Southeast PCGroup PAC ID 3779497045, 71 clinicians
Emergency Coverage LLCGroup PAC ID 3072412592, 761 clinicians

Practice addresses (Care Compare)

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

2122 Manchester Expy
Columbus, GA 31904-6878
Phone (706) 596-4000

615 Ridge Rd
Roxboro, NC 27573-4629
Phone (336) 599-2121

6801 Gov G C Peery Hwy
Richlands, VA 24641
Phone (276) 596-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
98.67
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2021-00621NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Western Carolina Emergency Physicians, PLLC Emergency Medicine CurrentSince Oct 1, 2021 Accepting new patients
Ballantyne Emergency Physicians PLLC Emergency Medicine CurrentSince Oct 5, 2021 Accepting new patients
Stallings Emergency Physicians, PLLC Emergency Medicine CurrentSince Dec 1, 2021 Accepting new patients
Carolinas Medical Center Current Accepting new patients
Emergency Coverage, LLC Emergency Medicine CurrentSince Jul 1, 2023 Accepting new patients
Ballantyne Emergency Physicians PLLC Emergency Medicine CurrentSince Oct 5, 2021 Accepting new patients
The Carolinas Emergency Group, PLLC Emergency Medicine CurrentSince Oct 5, 2021 Accepting new patients
Greenbrier Emergency Services, Inc. Emergency Medicine CurrentSince Mar 20, 2024 Accepting new patients
Carolinas Pathology Group, PA Current Accepting new patients
Carolinas Medical Center Emergency Medicine CurrentSince Jul 6, 2021 Accepting new patients
Health Care Alliance, Inc. Emergency Medicine CurrentSince Mar 20, 2024 Accepting new patients
Inphynet Primary Care Physicians Southeast PC Emergency Medicine CurrentSince Aug 1, 2023 Accepting new patients
Emergency Medicine Physicians of Mecklenburg County, PLLC Emergency Medicine CurrentSince Sep 23, 2021 Accepting new patients
Carolinas Medical Center CurrentSince Jul 6, 2021 Accepting new patients

Locations

1643 NW 136th Ave
Ste 100
Sunrise, FL 33323
Phone (865) 500-1325

2122 Manchstr Expy
Columbus, GA 31904
Phone (706) 320-3128

100 N 6th St
Ste 900A
Minneapolis, MN 55403

301 Yadkin St
Albemarle, NC 28001
Phone (704) 984-4000

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

10628 Park Rd
Charlotte, NC 28210
Phone (704) 543-2000

11516 Providence Rd
Charlotte, NC 28277
Phone (704) 667-0370

16035 Johnston Rd
Charlotte, NC 28277
Phone (704) 542-5132

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

1000 Healing Way
Matthews, NC 28104
Phone (800) 821-1535

600 Hospital Dr
Monroe, NC 28112
Phone (704) 283-3100

2201 S Sterling St
Morganton, NC 28655
Phone (828) 580-6393

615 Ridge Rd
Roxboro, NC 27573
Phone (336) 503-5699

2301 US Highway 74 W
Wadesboro, NC 28170
Phone (704) 694-5131

2700 S Providence Rd
Waxhaw, NC 28173
Phone (704) 243-2254

265 Brookview Centre Way
Ste 203
Knoxville, TN 37919
Phone (865) 985-7114

142 S Main St
Danville, VA 24541
Phone (434) 799-2100

20 Hospital Dr
Logan, WV 25601
Phone (304) 792-1101

601 Colliers Way
Weirton, WV 26062
Phone (304) 364-5156

Interoperability endpoints

  • Direct secure messaging: eklesick536633@carolinashealthcaresystem.direct-ci.com
  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 14

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

View all 14

Hospital & facility affiliations 7

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": "1459036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1073975215",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-355-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLESICK",
        "first_name": "ELISE",
        "middle_name": "MARIE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-27",
        "last_updated": "2023-05-04",
        "certification_date": "2022-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2021-00621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eklesick536633@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1000 Blythe Blvd",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282035812",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "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"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.