NPIMap

Organization Active NPI

Carolinas Medical Center

  • Plastic Surgery Physician
  • Charlotte, NC
National Provider Identifier
1154525293
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
CAROLINAS MEDICAL CENTER
Practice address
1025 Morehead Medical Dr
Ste 200
Charlotte, NC 28204-2963
Phone
(704) 466-6810
NPI assigned
Jun 13, 2007
Organization subpart
Yes
Parent organization
CAROLINAS MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Authorized official

Name
Scott Rissmiller
Title
Enterprise Evp
Phone
(704) 355-8675

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

1025 Morehead Medical Dr
Ste 200
Charlotte, NC 28204-2963

Mailing address

PO Box 19305
Charlotte, NC 28219-9305
Phone (704) 631-0002

Other practice location 1

1001 Blythe Blvd
Charlotte, NC 28203-5866
Phone (704) 446-6810

Other names 3

  • Atrium Health Levine Children's Cleft, Craniofacial & Plastic Surge Doing business as
  • Atrium Health Plastic & Reconstructive Surgery Charlotte Doing business as
  • CMC Cosmetic and Plastic Surgery Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network
Direct Messaging Address Ambulatory@direct.carolinashealthcare.org Atrium Health

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031110000116 NC Part B Supplier - Clinic/Group Practice 4789597477 Receives reassigned benefits from 2,635 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 30

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 30

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0988826Atrium Health Plastic and Reconstructive1025 Morehead Medical Drive, Suite 200, Charlotte, NC 28204ComplianceDec 16, 2026

National Provider Directory

National Provider Directory
Part of
Ctr for Mental Health

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678320000000",
    "number": "1154525293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305",
            "telephone_number": "704-631-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MOREHEAD MEDICAL DR",
            "address_2": "STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042963",
            "telephone_number": "704-466-6810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 Blythe Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035866",
            "country_code": "US",
            "telephone_number": "704-446-6810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAROLINAS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS MEDICAL CENTER",
        "enumeration_date": "2007-06-13",
        "last_updated": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "RISSMILLER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "ENTERPRISE EVP",
        "authorized_official_telephone_number": "704-355-8675"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1025 Morehead Medical Dr",
            "address_2": "Ste 200",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282042963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Atrium Health Levine Children's Cleft, Craniofacial & Plastic Surge",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Atrium Health Plastic & Reconstructive Surgery Charlotte",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CMC Cosmetic and Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 9, 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.