Organization Active NPI

Carolinas Physicians Network, Inc.

  • Family Medicine Physician
  • Cornelius, NC
National Provider Identifier
1154587103
Registry record updated Oct 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CAROLINAS PHYSICIANS NETWORK, INC.
Practice address
9606 Caldwell Commons Cir
Ste B
Cornelius, NC 28031-8111
Phone
(704) 892-3213
Fax
(704) 892-3966
NPI assigned
Jul 30, 2008
Organization subpart
Yes
Parent organization
CAROLINAS PHYSICIANS NETWORK, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 14, 2008

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

Authorized official

Name
Mr. Daniel L. Wiens
Title
Sr. Vice President
Phone
(704) 355-0648

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

9606 Caldwell Commons Cir
Ste B
Cornelius, NC 28031-8111

Mailing address

PO Box 602095
Charlotte, NC 28260-2095
Phone (704) 892-3213

Other names 1

  • Cornelius Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031219000455 NC Part B Supplier - Clinic/Group Practice 3375449655 Receives reassigned benefits from 1,949 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Part of
Cotswold Urgent Care

Practitioners & affiliated clinicians

Practitioners 1

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": "1217376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223942400000",
    "number": "1154587103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602095",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602095",
            "telephone_number": "704-892-3213",
            "fax_number": "704-892-3966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9606 CALDWELL COMMONS CIR",
            "address_2": "STE B",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280318111",
            "telephone_number": "704-892-3213",
            "fax_number": "704-892-3966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAS PHYSICIANS NETWORK, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS PHYSICIANS NETWORK, INC.",
        "enumeration_date": "2008-07-30",
        "last_updated": "2008-10-14",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT",
        "authorized_official_telephone_number": "704-355-0648",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornelius Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cornelius, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; 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.