NPIMap

Organization Active NPI

Carolina Medicorp Enterprises Inc

  • Internal Medicine Physician
  • Charlotte, NC
National Provider Identifier
1104245760
Registry record updated Apr 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CAROLINA MEDICORP ENTERPRISES INC
Practice address
15235 John J Delaney Dr
Suite B
Charlotte, NC 28277-2835
Phone
(704) 384-7300
NPI assigned
Apr 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2014

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

Authorized official

Name
Geoffrey K Gardner
Title
VP of Finance
Phone
(704) 384-7300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

15235 John J Delaney Dr
Suite B
Charlotte, NC 28277-2835

Mailing address

PO Box 751803
Charlotte, NC 28275-1803

Other names 1

  • Novant Health Express Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040110000190 NC Part B Supplier - Clinic/Group Practice 0648174904 Receives reassigned benefits from 249 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cornelius, NC; Greensboro, NC; High Point, NC; Huntersville, NC; Indian Trail, NC; Kernersville, NC; Lexington, NC; Matthews, NC…

Other NPIs on the same Medicare enrollment 32

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

View all 32

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397088000000",
    "number": "1104245760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15235 JOHN J DELANEY DR",
            "address_2": "SUITE B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772835",
            "telephone_number": "704-384-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA MEDICORP ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-10",
        "last_updated": "2014-04-10",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "704-384-7300"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Express",
            "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 Apr 10, 2014; 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.

Verify at the official NPI Registry.