Individual provider Active NPI

Kathryn Elizabeth Coomes, MPT

  • Physical Therapist
  • Charlotte, NC
National Provider Identifier
1104800135
Registry record updated Feb 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
P18957 Issued in NC
Practice address
2400 W Mallard Creek Church Rd
Charlotte, NC 28262-2324
Phone
(704) 323-2090
NPI assigned
Dec 2, 2005
Last updated
Feb 18, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X P18957 NC Primary
Physical Therapist 225100000X 05005065A IN

Addresses

Primary practice location

2400 W Mallard Creek Church Rd
Charlotte, NC 28262-2324

Mailing address

4601 Park Rd Ste 300
Charlotte, NC 28209-2290
Phone (704) 323-2090

Other identifiers 1

IdentifierTypeStateIssuer
0397730041OtherNCNSC #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190815000980 NC Practitioner - Physical Therapist in Private Practice 4183602865 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05005065AINMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-State Orthopaedic Surgeons, Inc. Current Accepting new patients
Orthocarolina Physical Therapist CurrentSince Feb 28, 2022 Accepting new patients
Orthocarolina Physical Therapist CurrentSince Feb 28, 2022 Accepting new patients
Tri-State Orthopaedic Surgeons, Inc. CurrentSince Jul 1, 2014 Accepting new patients
Tri-State Orthopaedic Surgeons, Inc. Physical Therapist CurrentSince Jul 1, 2014 Accepting new patients
Breakthrough Physical Therapy Physical Therapist PastSince Jul 29, 2019 Accepting new patients

Locations

225 Crosslake Dr
Evansville, IN 47715
Phone (812) 471-6677

7300 E Indiana St
Ste 102
Evansville, IN 47715
Phone (812) 759-7451

8887 High Pointe Dr
Ste E
Newburgh, IN 47630
Phone (812) 759-7464

2121 Willow St
Vincennes, IN 47591
Phone (812) 882-1141

1915 Randolph Rd
Charlotte, NC 28207
Phone (704) 339-1000

2400 W Mallard Creek Church Rd
Charlotte, NC 28262
Phone (704) 323-2090

4601 Park Rd
Ste 300
Charlotte, NC 28209
Phone (704) 323-2090

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645142400000",
    "number": "1104800135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 PARK RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282092290",
            "telephone_number": "704-323-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 W MALLARD CREEK CHURCH RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282622324",
            "telephone_number": "704-323-2090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOMES",
        "first_name": "KATHRYN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-02",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P18957",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05005065A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NSC #",
            "identifier": "0397730041",
            "state": "NC"
        }
    ],
    "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 Feb 18, 2022; 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.