Northlake Pediatric Care PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

NORTHLAKE PEDIATRIC CARE PA

Practice address

2117 Simonton Rd
Suite 402
Statesville, NC 28625-8206

Phone

(704) 871-2323

Fax

(803) 619-2149

NPI assigned

Aug 20, 2006

Last updated

May 30, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Borja, MDNPI 1023125861

Title

Owner

Phone

(704) 871-2323

Specialties & licenses 1

Addresses

Other identifiers 3

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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.

• Michael Borja, MD

  • Pediatrics Physician
  • Statesville, NC
  • NPI 1023125861
  NPD (past) Authorized official
• Diane Marie Caruso, FNP

  • Nurse Practitioner
  • Cleveland, NC
  • NPI 1205831369
  NPD (past)

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369872000000",
    "number": "1083729701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2117 SIMONTON RD",
            "address_2": "SUITE 402",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286258206",
            "telephone_number": "704-871-2323",
            "fax_number": "803-619-2149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 SIMONTON RD",
            "address_2": "SUITE 402",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286258206",
            "telephone_number": "704-871-2323",
            "fax_number": "803-619-2149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE PEDIATRIC CARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2013-05-30",
        "status": "A",
        "authorized_official_last_name": "BORJA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-871-2323",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "1002P",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID",
            "identifier": "34D1014813",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5918872",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• North Carolina Support Services
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• Novant Health Davis Medical Center, LLC (Novant Health Davis Medical Center)
• Novant Health Medical Group, LLC (Novant Health Primary Care Fern Creek)

• Pediatrics Physician in Statesville, NC
• Providers in Statesville, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.