NPIMap

Organization Active NPI

Select Health Pain and Regenerative Medicine PC

  • General Practice Physician
  • Charlotte, NC
National Provider Identifier
1124636667
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
SELECT HEALTH PAIN AND REGENERATIVE MEDICINE PC
Practice address
15720 Brixham Hill Ave Ste 130
Charlotte, NC 28277-4784
Phone
(704) 541-5555
NPI assigned
Jul 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Authorized official

Name
Eric ShapiroNPI 1669415154
Title
President
Phone
(704) 763-2151

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

15720 Brixham Hill Ave Ste 130
Charlotte, NC 28277-4784

Mailing address

15720 Brixham Hill Ave Ste 130
Charlotte, NC 28277-4784
Phone (704) 541-5555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200917001941 NC Part B Supplier - Clinic/Group Practice 0143648477 Receives reassigned benefits from 6 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory

Locations

15720 Brixham Hill Ave
Ste 130
Charlotte, NC 28277
Phone (704) 541-5555

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1124636667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15720 BRIXHAM HILL AVE STE 130",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282774784",
            "telephone_number": "704-541-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15720 BRIXHAM HILL AVE STE 130",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282774784",
            "telephone_number": "704-541-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELECT HEALTH PAIN AND REGENERATIVE MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-21",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "SHAPIRO",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-763-2151"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.