Active NPI
Caromont Medical Group Inc
- Internal Medicine Physician
- Gastonia, NC
National Provider Identifier
1093005159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- CAROMONT MEDICAL GROUP INC
- Practice address
- 1040 X Ray Dr
Suite B
Gastonia, NC 28054-5438 - Phone
- (704) 884-0064
- Fax
- (704) 884-0074
- NPI assigned
- Apr 11, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Randall L Kelley
- Title
- President/Ceo
- Phone
- (704) 671-5343
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | Primary |
Addresses
Primary practice location
1040 X Ray Dr
Suite B
Gastonia, NC 28054-5438
Mailing address
1040 X Ray Dr Ste B
Gastonia, NC 28054-7488
Phone (704) 884-0064
Other names 1
- Adult Primary and Preventive Medicine
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
1040 X Ray Dr
Ste B
Gastonia, NC 28054
Phone (704) 884-0064
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Mint Hill, NC
- NPI 1922385749
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302480000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1564963200000",
"number": "1093005159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1040 X RAY DR STE B",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280547488",
"telephone_number": "704-884-0064",
"fax_number": "704-884-0074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 X RAY DR",
"address_2": "SUITE B",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280545438",
"telephone_number": "704-884-0064",
"fax_number": "704-884-0074"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CAROMONT MEDICAL GROUP INC",
"organizational_subpart": "NO",
"enumeration_date": "2011-04-11",
"last_updated": "2019-08-05",
"status": "A",
"authorized_official_last_name": "KELLEY",
"authorized_official_first_name": "RANDALL",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "704-671-5343"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Adult Primary and Preventive Medicine",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Adult Primary and Preventive Medicine",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Gastonia, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; 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.