NPIMap

Organization Active NPI

The Charlotte-Mecklenburg Hospital Authority

Doing business as Carolinas Rehabilitation

  • Physical Medicine & Rehabilitation Physician
  • Charlotte, NC
National Provider Identifier
1104976315
Registry record updated Apr 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Doing business as
Carolinas Rehabilitation
Practice address
1100 Blythe Blvd
Charlotte, NC 28203-5814
Phone
(704) 355-4300
Fax
(704) 355-4231
NPI assigned
Jan 11, 2007
Last updated
Apr 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2011

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

Authorized official

Name
Mr. Greg Gombar
Title
Administrator
Phone
(704) 355-2154

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X NU Primary

Addresses

Primary practice location

1100 Blythe Blvd
Charlotte, NC 28203-5814

Mailing address

PO Box 32861
Charlotte, NC 28232-2861
Phone (704) 512-6438

Other identifiers 1

IdentifierTypeStateIssuer
6001913MedicaidNC

Other names 1

  • Carolinas Rehabilitation Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Carolinas Rehabilitation4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303171200000",
    "number": "1104976315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32861",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282322861",
            "telephone_number": "704-512-6438",
            "fax_number": "704-512-6485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035814",
            "telephone_number": "704-355-4300",
            "fax_number": "704-355-4231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2011-04-19",
        "status": "A",
        "authorized_official_last_name": "GOMBAR",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-355-2154",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6001913",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolinas Rehabilitation",
            "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 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.