NPIMap

Organization Active NPI

Fort Health Medical Group PA

  • Child & Adolescent Psychiatry Physician
  • Charlotte, NC
National Provider Identifier
1114766284
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
FORT HEALTH MEDICAL GROUP PA
Practice address
212 S Tryon St Ste 100
Charlotte, NC 28281-0033
Phone
(201) 208-2616
Fax
(973) 381-5773
NPI assigned
May 20, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Authorized official

Name
Traci Crosby
Title
Credentialing Manager
Phone
(201) 503-4815

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X Primary

Addresses

Primary practice location

212 S Tryon St Ste 100
Charlotte, NC 28281-0033

Mailing address

613 Washington Blvd # 1297
Jersey City, NJ 07310-2900
Phone (201) 208-2616

Other names 1

  • Fort Health Medical Group of NC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fort Health Medical Group5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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": "1716163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1114766284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 WASHINGTON BLVD # 1297",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073102900",
            "telephone_number": "201-208-2616",
            "fax_number": "973-381-5773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 S TRYON ST STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282810033",
            "telephone_number": "201-208-2616",
            "fax_number": "973-381-5773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT HEALTH MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "CROSBY",
        "authorized_official_first_name": "TRACI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "201-503-4815"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Health Medical Group of NC",
            "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 20, 2024; 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.