Piedmont Family Medicine, P.a.
Organization Active NPI Primary Care Clinic/Center · Salisbury, NC
NPI 1104968627 · NPPES record last updated Jun 3, 2013
Key facts
- NPI
- 1104968627
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- PIEDMONT FAMILY MEDICINE, P.A.
- Practice address
- 1401 W Innes St Ste B
Salisbury, NC 28144-2575 - Phone
- (704) 636-5626
- Fax
- (704) 636-5641
- NPI assigned
- Feb 12, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Chetan N Amin, D.O.
- Title
- Owner
- Phone
- (704) 636-5626
Corporate family (same tax ID) 1
Practitioners 4
-
Chetan N Amin, DO
-
Lauren Elizabeth Graham, PA-C
-
Nicole Graham, PA-C
-
Tiffany Marie Kneip, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0243546 | Piedmont Family Medicine | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080926000556 | NC | Part B Supplier - Clinic/Group Practice | 8426125816 |
Receives reassigned benefits from 4 practitioners Practice locations: Salisbury, NC |
National Provider Directory
- Tax ID family
- Nicole Graham
Locations
1710 W Innes St
Salisbury, NC 28144
Phone (704) 636-1400
1401 W Innes St
Salisbury, NC 28144
Phone (704) 633-2612
Interoperability endpoints
- chetan-amin@piedmontfm.e-mdsdirect.com
- admin@piedmontfm.e-mdsdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
1401 W Innes St Ste B
Salisbury, NC 28144-2575
Mailing address
1401 W Innes St Ste B
Salisbury, NC 28144-2575
Phone (704) 636-5626
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 012MO | Other | NC | BCBS GROUP NUMBER |
Other providers in Salisbury, NC
- Phase II Transportation Inc
- Peatra Lehr Phifer
- Jeffrey Phillips
- Taylor Phillips
- Piedmont Eye Physicians and Surgeons, PA
- Piedmont Foot and Ankle Care
- Piedmont Health & Rehab Center, LLC
- Piedmont Interventional Pain Care, PA
- Piedmont Neurosurgery & Spine, PA
- Piedmont Plastic & Oral Surgery Center
All providers in Salisbury, NC · Primary Care Clinic/Center in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.