NPIMap

Organization Active NPI

The Presbyterian Hospital

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Charlotte, NC
National Provider Identifier
1104145390
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X
Legal business name
THE PRESBYTERIAN HOSPITAL
Practice address
300 Billingsley Rd
Suite 105
Charlotte, NC 28211-1084
Phone
(704) 384-4098
Fax
(704) 384-4173
NPI assigned
May 27, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Authorized official

Name
Leea Jeanine Walton
Title
RCS Manager
Phone
(704) 316-6081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0011X Primary

Addresses

Primary practice location

300 Billingsley Rd
Suite 105
Charlotte, NC 28211-1084

Mailing address

PO Box 601529
Charlotte, NC 28260-1529
Phone (704) 384-4098

Other names 1

  • Novant Health Wound Care and Hyperbaric Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031126000588 NC Part B Supplier - Clinic/Group Practice 1153231907 Receives reassigned benefits from 77 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charlotte, NC; Huntersville, NC

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2016686Novant Health Wound Care and Hyperbaric Medicine300 Billingsley Road, Suite 105, Charlotte, NC 28211Certificate of waiverNov 22, 2026

National Provider Directory

National Provider Directory
Tax ID family
Presbyterian Hosp Sup51 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Locations

1381 Westgate Center Dr
Winston Salem, NC 27103
Phone (336) 718-0100

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1104145390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601529",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601529",
            "telephone_number": "704-384-4098",
            "fax_number": "704-384-4173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 BILLINGSLEY RD",
            "address_2": "SUITE 105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111084",
            "telephone_number": "704-384-4098",
            "fax_number": "704-384-4173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PRESBYTERIAN HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-27",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "2083P0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Wound Care and Hyperbaric Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Wound Care and Hyperbaric Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.