Active NPI
Heather Graham, M.D.
- Obstetrics & Gynecology Physician
- Charlotte, NC
National Provider Identifier
1104089952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 2015-01105
- Practice address
- 1918 Randolph Rd
Suite 670
Charlotte, NC 28207-1100 - Phone
- (704) 384-1620
- Fax
- (704) 384-1626
- NPI assigned
- Jul 2, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Obstetrics & Gynecology Physician | 207V00000X | 2015-01105 | NC | Primary |
Addresses
Primary practice location
1918 Randolph Rd
Suite 670
Charlotte, NC 28207-1100
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-1620
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Obstetrics/Gynecology
- Education
- University of Alabama School of Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2310 Randolph Rd
Suite B
Charlotte, NC 28207-1526
Phone (704) 650-7156
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015-01105 | NC | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Gynecology & Wellness, PLLC | Current | Accepting new patients | |
| Mary Rutan Hospital | Past | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Locations
2310 Randolph Rd
Ste B
Charlotte, NC 28207
Phone (704) 650-7156
2310 Randolph Rd
Unit B
Charlotte, NC 28207
Phone (704) 650-7156
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EBIEBD/Endpoint/EBIEBD
Organizations & group practices 3
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.
-
- Medical Specialty Clinic/Center
- Charlotte, NC
- NPI 1720578313
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
-
- Family Medicine Physician
- West Liberty, OH
- NPI 1003875949
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439337600000",
"number": "1104089952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60447",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282600447",
"telephone_number": "704-384-1620",
"fax_number": "704-384-1626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1918 RANDOLPH RD",
"address_2": "SUITE 670",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282071100",
"telephone_number": "704-384-1620",
"fax_number": "704-384-1626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "HEATHER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-02",
"last_updated": "2015-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "NC",
"license": "2015-01105",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
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 Aug 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.