Individual provider Active NPI

Courtney Rae Jennings, AUD

  • Audiologist
  • Charlotte, NC
National Provider Identifier
1124470265
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
12097 Issued in NC
Practice address
6035 Fairview Rd
Charlotte, NC 28210-3256
Phone
(704) 295-3000
NPI assigned
Jul 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 4061 SC
Audiologist 231H00000X 12097 NC Primary

Addresses

Primary practice location

6035 Fairview Rd
Charlotte, NC 28210-3256

Mailing address

6035 Fairview Rd
Charlotte, NC 28210-3256
Phone (704) 295-3000

Other identifiers 2

IdentifierTypeStateIssuer
Q54201AOtherNCMEDICARE
SAN137MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cmatthews6284@direct.ceenta.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160920000039 NC Practitioner - Qualified Audiologist 9234426255 Reassigns benefits to 1 organization
I20170123001363 SC Practitioner - Qualified Audiologist 9234426255 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

200 S Herlong a
Rock Hill, SC 29732-1182
Phone (803) 328-1864

6035 Fairview Rd
Charlotte, NC 28210-3256
Phone (704) 295-3000

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
12097NCMDDentist
4061SCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Charlotte Eye Ear Nose & Throat Associates, P.a. Audiologist CurrentSince Jul 19, 2016 Accepting new patients
Charlotte Eye Ear Nose & Throat Associates, PA CurrentSince Jul 19, 2016 Accepting new patients
Charlotte Eye Ear Nose & Throat Associates, PA PastSince Apr 13, 2025 Accepting new patients

Locations

1908 Hilco St
Ste A
Albemarle, NC 28001
Phone (704) 982-8686

400 Park St
Belmont, NC 28012
Phone (704) 295-3700

5933 Blakeney Park Dr
Ste 200
Charlotte, NC 28277
Phone (704) 295-3311

13532 Steelecroft Pkwy
Charlotte, NC 28278
Phone (704) 295-3475

400 E Brooklyn Village Ave
Ste A1
Charlotte, NC 28202
Phone (704) 295-3110

2325 W Arbors Dr
Ste 201
Charlotte, NC 28262
Phone (704) 295-3500

6035 Fairview Rd
Charlotte, NC 28210
Phone (336) 718-2078

645 Amalia St NE
Concord, NC 28025
Phone (704) 295-3255

10305 Hamptons Park Dr
Ste 201
Huntersville, NC 28078
Phone (704) 295-3600

724 Aubrey Bell Dr
Ste 201
Matthews, NC 28105

1632 E Roosevelt Blvd
Monroe, NC 28112
Phone (704) 295-3725

10405 Centrum Pkwy
Pineville, NC 28134
Phone (704) 295-3650

1698 Highway 160 W
Ste 240
Fort Mill, SC 29708
Phone (803) 547-3800

601 Sutton Rd S
Ste 201
Fort Mill, SC 29715
Phone (803) 328-1864

838 W Meeting St
Ste C
Lancaster, SC 29720
Phone (803) 286-8626

200 Herlong Ave S
Ste A
Rock Hill, SC 29732
Phone (803) 324-1028

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1468281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1124470265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6035 FAIRVIEW RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103256",
            "telephone_number": "704-295-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6035 FAIRVIEW RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103256",
            "telephone_number": "704-295-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "COURTNEY",
        "middle_name": "RAE",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-12",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "SC",
            "license": "4061",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NC",
            "license": "12097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Q54201A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SAN137",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmatthews6284@direct.ceenta.com",
            "affiliation": "N",
            "address_1": "6035 Fairview Rd",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282103256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Oct 10, 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.