Individual provider Active NPI

Jerry Dale Nix, M.D.

  • Emergency Medicine Physician
  • Charlotte, NC
National Provider Identifier
1083668495
Registry record updated Dec 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
94-00314 Issued in NC
Practice address
501 S Sharon Amity Rd Ste 300
Charlotte, NC 28211-0035
Phone
(704) 377-2424
Fax
(704) 377-2687
NPI assigned
May 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 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 94-00314 NC Primary

Addresses

Primary practice location

501 S Sharon Amity Rd Ste 300
Charlotte, NC 28211-0035

Mailing address

501 S Sharon Amity Rd Ste 300
Charlotte, NC 28211-0035
Phone (704) 377-2424

Other identifiers 4

IdentifierTypeStateIssuer
930067199OtherNCRR MEDICARE
89-62710MedicaidNC
62710OtherNCBCBSNC
N00314MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050106000264 NC Practitioner - Emergency Medicine 8527016500 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of North Carolina at Chapel Hill School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-Atlantic Emergency Medical Associates PLLCGroup PAC ID 4880686823, 100 clinicians

Practice addresses (Care Compare)

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 377-2424

Hospital & facility affiliations

  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
94-00314NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cfvhs Ed Physicians Emergency Medicine CurrentSince Dec 19, 2012 Accepting new patients
Cfvhs Ed Physicians Emergency Medicine Current Accepting new patients
Mid-Atlantic Emergency Medical Associates, PLLC Emergency Medicine CurrentSince Jul 1, 1998 Accepting new patients
Mema SC LLC Emergency Medicine PastSince Oct 13, 2024 Accepting new patients

Locations

1900 Randolph Rd
Ste 900
Charlotte, NC 28207
Phone (704) 377-2424

501 S Sharon Amity Rd
Ste 300
Charlotte, NC 28211
Phone (704) 319-5821

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

Organizations & group practices 4

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 4

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": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1083668495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S SHARON AMITY RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282110035",
            "telephone_number": "704-377-2424",
            "fax_number": "704-377-2687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S SHARON AMITY RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282110035",
            "telephone_number": "704-377-2424",
            "fax_number": "704-377-2687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIX",
        "first_name": "JERRY",
        "middle_name": "DALE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "94-00314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "930067199",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89-62710",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "62710",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N00314",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.