South Charlotte General and Vascular Surgery PLLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

2009-00158 Issued in NC

Legal business name

SOUTH CHARLOTTE GENERAL AND VASCULAR SURGERY PLLC

Practice address

13430 Hoover Creek Blvd Ste 200
Charlotte, NC 28273-0054

Phone

(704) 910-8380

Fax

(704) 710-8045

NPI assigned

Jan 5, 2011

Last updated

May 30, 2023By 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

Dr. James Nelson Antezana, M.D.NPI 1134174436

Title

General and Vascular Surgeon

Phone

(803) 412-5126

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC, SC2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 11

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.

• James N. Antezana, MD

  • Vascular Surgery Physician
  • Charlotte, NC
  • NPI 1134174436

  SC

  Medicare reassignment Care Compare group NPD Authorized official
• Michelle Julittee Grant

  • Family Nurse Practitioner
  • Charlotte, NC
  • NPI 1982440012
  Medicare reassignment Care Compare group NPD
• James Kuo-Li Liu, MD

  • Cardiovascular Disease Physician
  • Charlotte, NC
  • NPI 1720020977
  Medicare reassignment Care Compare group NPD
• Theophania Ofori Buah, AGPCNP

  • Gerontology Nurse Practitioner
  • Statesville, NC
  • NPI 1992549430
  Medicare reassignment Care Compare group NPD
• Steven Arthur Weston, MD

  • Surgery Physician
  • Hilton Head Island, SC
  • NPI 1760402093

  NC

  Medicare reassignment Care Compare group NPD
• Peter Ford, M.D.

  • Vascular Surgery Physician
  • Charlotte, NC
  • NPI 1891917431
  Medicare reassignment NPD
• Bhumika Nilay Patel

  • Nurse Practitioner
  • Charlotte, NC
  • NPI 1720661143
  Medicare reassignment NPD
• Sharena C Gamble, FNP

  • Family Nurse Practitioner
  • Rock Hill, SC
  • NPI 1932825577

  NC

  Medicare reassignment NPD
• Nehal Modha, DPM

  • Foot & Ankle Surgery Podiatrist
  • Fort Mill, SC
  • NPI 1508495714
  Medicare reassignment NPD (past)
• Michael Broussard, DPM

  • Podiatrist
  • Charlotte, NC
  • NPI 1427793074
  NPD
• Paul R Steadman, M.D.

  • General Practice Physician
  • Gaffney, SC
  • NPI 1033480462
  NPD (past)

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

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685404800000",
    "number": "1144524190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13430 HOOVER CREEK BLVD STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282730054",
            "telephone_number": "704-910-8380",
            "fax_number": "704-710-8045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13430 HOOVER CREEK BLVD STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282730054",
            "telephone_number": "704-910-8380",
            "fax_number": "704-710-8045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CHARLOTTE GENERAL AND VASCULAR SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A",
        "authorized_official_last_name": "ANTEZANA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "NELSON",
        "authorized_official_title_or_position": "GENERAL AND VASCULAR SURGEON",
        "authorized_official_telephone_number": "803-412-5126",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "2009-00158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59-13992",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Charlotte Behavioral Health
• South Charlotte Cardiology, P.C.
• South Charlotte Chiropractic PLLC
• South Charlotte Counseling and Psychotherapy, PLLC
• South Charlotte Dermatology, PC
• South Charlotte Pain Relief Center, Inc.
• South Charlotte Pediatrics, PLLC
• South Charlotte Physical Therapy LLC
• South Charlotte Primary Care (Atrium Health Primary Care South Charlotte Internal Medicine)
• South Charlotte Rheumatology, PLLC

• Surgery Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; 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.