The Custom Source Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

THE CUSTOM SOURCE INC

Practice address

1013 Chestnut LN Ste 120
Matthews, NC 28104-8567

Phone

(704) 893-5457

Fax

(704) 973-0696

NPI assigned

Dec 7, 2005

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kasey Rolfes, DHA, ATCNPI 1306830526

Title

Operations Manager

Phone

(704) 893-5457

Specialties & licenses 3

Addresses

Other identifiers 2

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kasey Rolfes, DHA, LAT, RCEP

  • Athletic Trainer
  • Prince Frederick, MD
  • NPI 1306830526
  NPD Authorized official
• Mark R Chapman Jr., COF

  • Orthotic Fitter
  • Matthews, NC
  • NPI 1033595707
  NPD (past)
• Thomas J Morgan, MS, LAT,ATC,PES,EMT

  • Athletic Trainer
  • Matthews, NC
  • NPI 1407848070
  NPD (past)

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1114902665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 CHESTNUT LN STE 120",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281048567",
            "telephone_number": "704-893-5457",
            "fax_number": "704-973-0696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 CHESTNUT LN STE 120",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281048567",
            "telephone_number": "704-893-5457",
            "fax_number": "704-973-0696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CUSTOM SOURCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-07",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ROLFES",
        "authorized_official_first_name": "KASEY",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "704-893-5457",
        "authorized_official_credential": "DHA, ATC"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthotist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS/NC",
            "identifier": "0491E",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7700578",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Matthews, NC
• Providers in Matthews, NC by specialty
• Prosthetic/Orthotic Supplier in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.