Active NPI
Carolinas Physicians Network Inc
- Surgery Physician
- Waxhaw, NC
National Provider Identifier
1134477466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- CAROLINAS PHYSICIANS NETWORK INC
- Practice address
- 2700 Providence Rd S
Suite 225
Waxhaw, NC 28173-6313 - Phone
- (704) 667-6700
- Fax
- (704) 667-6701
- NPI assigned
- Aug 16, 2012
- Organization subpart
- Yes
- Parent organization
- CAROLINAS PHYSICIANS NETWORK INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Daniel L Wiens
- Title
- Administrator
- Phone
- (704) 355-0648
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary |
Addresses
Primary practice location
2700 Providence Rd S
Suite 225
Waxhaw, NC 28173-6313
Mailing address
PO Box 601888
Charlotte, NC 28260-1888
Phone (704) 667-6700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5919558 | Medicaid | NC | |
| NPB468 | Medicaid | SC |
Other names 1
- Union Surgical Associates
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040115000819 | NC | Part B Supplier - Clinic/Group Practice | 3375449655 |
Receives reassigned benefits from 2,518 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- Cotswold Urgent Care
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345075200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1354579200000",
"number": "1134477466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 601888",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282601888",
"telephone_number": "704-667-6700",
"fax_number": "704-667-6701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 PROVIDENCE RD S",
"address_2": "SUITE 225",
"city": "WAXHAW",
"state": "NC",
"postal_code": "281736313",
"telephone_number": "704-667-6700",
"fax_number": "704-667-6701"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CAROLINAS PHYSICIANS NETWORK INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CAROLINAS PHYSICIANS NETWORK INC",
"enumeration_date": "2012-08-16",
"last_updated": "2012-12-04",
"status": "A",
"authorized_official_last_name": "WIENS",
"authorized_official_first_name": "DANIEL",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "704-355-0648"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5919558",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NPB468",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Union Surgical Associates",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Waxhaw, NC
- Caresmatic Phase 1,Inc.
- Carolina Home Access
- Carolina Home Health Care Inc.
- Carolinas CC Chiropractic PLLC
- Carolinas Physicians Network Inc
- Carolinas Physicians Network Inc
- Carolinas Physicians Network Inc
- Carolinas Physicians Network Inc
- Carolinas Physicians Network Inc.
- Carolinas Physicians Network, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; 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.