Kodiak Medical PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

KODIAK MEDICAL PA

Practice address

10926 David Taylor Dr Ste 120-105
Charlotte, NC 28262-1293

Phone

(888) 566-4201

NPI assigned

Jan 28, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Sachin Surendra Mody, MD

Title

Owner

Phone

(855) 837-8808

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653004800000",
    "number": "1134872252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10926 DAVID TAYLOR DR STE 120-105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282621293",
            "telephone_number": "888-566-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10926 DAVID TAYLOR DR STE 120-105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282621293",
            "telephone_number": "888-566-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KODIAK MEDICAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-28",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A",
        "authorized_official_last_name": "MODY",
        "authorized_official_first_name": "SACHIN",
        "authorized_official_middle_name": "SURENDRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "855-837-8808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134872252",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meredith Was Kocher
• Chanpreet Kochhar
• Amanda Lockard Kochosky, AGACNP
• Kelsey Kocjancic
• Jonathan Kocmond, M.D.
• Kiara Daniela Kodikara
• Hailee N Koeckert, CRNA
• Matthew Anthony Koeckert, RN
• Jordyn Hudgins Koehler, PA-C
• Sarah Whitescarver Koehler

• Family Medicine Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.